B Lau, T L Lewis, R Ray, J Humphrey
MIS techniques represent a valuable addition to the foot and ankle surgeon's armamentarium for selected patients, rather than a universal replacement for traditional open surgery. Whilst some outcomes appear comparable to open techniques in appropriately selected patients treated by experienced surgeons, significant evidence gaps remain, particularly regarding long-term outcomes and patient selection. High-quality randomised trials with standardised outcome measures and structured training pathways are required.
BACKGROUND: Minimally invasive percutaneous surgery (MIS) techniques have gained popularity in foot and ankle surgery, offering potential advantages over traditional open procedures, including reduced soft-tissue trauma, decreased postoperative pain and accelerated recovery. Concerns regarding the learning curve, precision of correction, and long-term outcomes have limited widespread adoption. This review evaluates the current evidence for MIS techniques across common foot and ankle pathologies.
METHODS: A narrative review of the literature was conducted searching MEDLINE and the Cochrane Library. Studies reporting MIS techniques for hallux valgus, lesser toe deformities, hallux rigidus, calcaneal osteotomy and arthrodesis procedures were included.
RESULTS: The largest evidence base exists for MIS hallux valgus correction, with multiple systematic reviews demonstrating comparable radiographic and functional outcomes to open techniques, with potential advantages in wound complications and early postoperative pain. Emerging evidence supports the use of MIS techniques for lesser metatarsalgia and calcaneal osteotomies. However, the literature is predominantly retrospective with heterogeneous techniques and limited long-term follow-up. Evidence for bunionette corrections and arthrodesis procedures is sparse, largely from small case series. The learning curve is substantial, and concerns regarding neurovascular safety and correction precision persist across applications.
CONCLUSIONS: MIS techniques represent a valuable addition to the foot and ankle surgeon's armamentarium for selected patients, rather than a universal replacement for traditional open surgery. Whilst some outcomes appear comparable to open techniques in appropriately selected patients treated by experienced surgeons, significant evidence gaps remain, particularly regarding long-term outcomes and patient selection. High-quality randomised trials with standardised outcome measures and structured training pathways are required.