CME OnDemand: Small Incisions, Big Results: MIS to the MAX-Course References

Course References

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This comprehensive compilation of references and an original study article focuses on minimally invasive surgical (MIS) techniques and associated complications across various foot and ankle pathologies, including hallux valgus, calcaneal osteotomies, lateral ankle instability, midfoot osteotomy, and gastrocnemius recession.<br /><br />A key highlighted study investigates complications after three common percutaneous calcaneal osteotomies—medializing calcaneal osteotomy (MDCO), Zadek osteotomy (ZO), and modified Dwyer osteotomy (DO)—in a retrospective series of 118 patients with an average 16-month follow-up. The overall postoperative complication rate was low at 3.4%, including transient sural neuritis (1.7%), prolonged wound drainage (0.8%), and a single nonunion (0.8%). There was no significant difference in complication rates between osteotomy types, and no complication correlated with preoperative comorbidities, including well-controlled diabetes. The study supports that percutaneous techniques reduce soft tissue injury, minimize wound complications, and are safe alternatives to open surgery for hindfoot correction, especially in patients at high risk for postoperative complications.<br /><br />Supplementary cited literature affirms the growing popularity and evolving advancements in MIS for correcting forefoot deformities like hallux valgus, with evidence favoring reduced pain, faster recovery, and comparable or improved clinical and radiographic outcomes versus open approaches. Meta-analyses and systematic reviews underscore the benefits of third-generation percutaneous Chevron and Akin osteotomies for hallux valgus and newer methods in treating bunionettes, metatarsalgia, and Morton's neuroma using minimally invasive distal metatarsal osteotomies.<br /><br />Additional references address arthroscopic and augmented repairs for lateral ankle instability, stressing biomechanical advantages and functional outcomes of suture tape augmentations in Broström procedures. Midfoot osteotomy advancements, including 3D-printed patient-specific instrumentation, improve surgical accuracy in complex cavovarus deformities. Proximal medial gastrocnemius recession is reviewed for its role in managing recalcitrant plantar fasciitis and mechanical metatarsalgia, with studies supporting its efficacy and safety.<br /><br />Overall, the literature supports a paradigm shift favoring percutaneous and minimally invasive foot and ankle procedures to reduce surgical morbidity while maintaining or enhancing functional results. Continued research and surgeon expertise development remain essential to optimizing patient outcomes and mitigating complications associated with these advanced surgical techniques.

Keywords

minimally invasive surgery

foot and ankle pathologies

hallux valgus

calcaneal osteotomies

lateral ankle instability

midfoot osteotomy

gastrocnemius recession

percutaneous techniques

surgical complications

postoperative outcomes