the foot and ankle as well as a novel technique. Some acknowledgements for participation on this project include Dr. Gary Stewart, Dr. Errol Bailey, Dr. Adesho Falue, and Dr. Uzoma Nwakibu. Some deformities we'll be discussing today that are commonly corrected with minimally invasive surgery include hallux valgus, bunionette, hammer toe, as well as pes planivalgus. Starting off with hallux valgus, this is a common deformity that affects the bony and soft tissue anatomy of the first MTP joint. There can be open versus minimally invasive techniques that are utilized to correct this. Some common open techniques include chevron and scarf osteotomies, which are reliable. However, they do have limited rotational correction, and they do rely on more soft tissue release. Minimally invasive techniques do allow for a little bit more freedom with that rotational deformity correction, and in theory do have an intact periosteal sleeve that can promote more bone healing. The literature does show comparative clinical and radiographic outcomes between open and MIS techniques, and does say that MIS is effective. However, there's a learning curve associated with it, and there is a lack of level one or two evidence that can make a recommendation for MIS over open at this point. Here is a chart more extensively going over the various techniques for treating hallux valgus, as well as the literature associated with them. Moving on to bunionette, this is a prominence of the fifth metatarsal head that's associated with an increased IM and MTP angle. Surgery is based off of symptoms rather than the magnitude of those angles, and here is the procedure. So briefly, the way to treat bunionette in an MIS fashion is typically with a DMMO or distal metatarsal metaphyseal osteotomy, and we recommend an oblique osteotomy to help prevent that dorsal displacement that can lead to transfer metatarsal to the fourth metatarsal head. Some risks and benefits. While there is no hardware, this is great for wound healing complications, especially in patients like diabetics who may have issues with that. However, there is a risk for non-union given that there is no hardware. And here is a chart going over the various types of bunionettes and the techniques, as well as literature associated with these techniques. Moving on to hammer toe deformity, which is an imbalance between flexion and extension, namely extension of the MTP joint with flexion of the PIP joint. And just a brief overview of that correction. The MIS technique is a more mature procedure for hammer toe deformity. It's been around for a little while longer and has lower complication rates. There are flexible and rigid types of hammer toe, and the various techniques associated with them are based off of that type. Here you can see flexible versus rigid and then concomitant MTP joint deformity, and the various techniques associated with these types and the literature associated with these techniques. Finally, with pes planivalgus, it was historically referred to as adult acquired flat foot deformity, we're now transitioning to a new nomenclature, namely progressive collapsing foot deformity. And here you can see the new nomenclature staging, stage one flexible versus stage two rigid, and then the type of deformity is class A through E. Minimally invasive procedures regarding pes planivalgus is dependent on flexible versus rigid deformity. In the rigid deformity, we're looking at more of an arthrodesis type technique, hind foot versus ankle fusion. With the flexible deformity, we have a lot of options available, including tendoscopy, calxite osteotomy, which we'll get to coming up here shortly. So here is a novel technique and an introduction for this PCFD. It's called the mini bear, which stands for all bone extra articular reconstruction of the PCFD. We combine a minimally invasive medial calxite osteotomy with a lateral column lengthening and a cotton osteotomy to allow for a quicker recovery time and better cosmetic outcomes. Starting off with the calcaneal osteotomy, historically, the flexible valgus heel was treated with an FDL transfer, but we now know that there needs to be some bony work done to have a more permanent correction. The calcaneal osteotomy has substituted nicely for this. The lateral column lengthening or the Evans osteotomy is used to correct the forefoot abduction seen in progressive collapsing flat foot. And we insert a metal cage in this to make a more standalone construct. Finally, the MIS cotton osteotomy is used when there is a severe loss of arch, and this is a dorsal wedge of the medial cuneiform. In conclusion, minimally invasive techniques do show promise, and the literature shows that they are safe and effective. However, there is limited high-level literature to show superiority at this time. There's a learning curve, but there are new procedures that come out that can challenge the boundaries of MIS, and the future is promising. Thank you.

minimally invasive surgery

foot and ankle deformities

rotational deformities

bone healing

bunionette correction