CME OnDemand: Small Incisions, Big Results: MIS to the MAX-Symposium 1: Where It All Began... The Bunion

Video Transcription

Video Summary

Tyler Gonzalez and John Kaplan opened a minimally invasive surgery (MIS) course focused on foot and ankle surgery, specifically hallux valgus correction techniques. The presenters emphasized audience engagement and a candid discussion of what techniques do and don’t work. A pre-meeting course on MIS is planned for May 2026. <br /><br />Dr. Joël Villeneuve delivered a historical overview of MIS osteotomies for hallux valgus, noting key advances such as the Hicham-Roverdin and Charon osteotomies and the development of the MICA fixation technique, which improved stability and acceptance worldwide despite initial opposition.<br /><br />Dr. Javier del Vecchio discussed the percutaneous intraarticular chevron osteotomy (PECO), illustrating its safety, efficacy, and shorter surgical times despite technical challenges and potential complications like fixation issues.<br /><br />David Gordon provided practical guidance on distal osteotomies, highlighting the importance of three-point fixation, mastering fluoroscopic imaging, and understanding the learning curve of approximately 30-40 cases. He emphasized benefits like reduced pain, faster recovery, and promising long-term outcomes.<br /><br />Holly Johnson described her Lapidus procedure approach, underscoring indications such as medial column instability and global hypermobility, while discussing surgical nuances, joint preparation with burrs, and the importance of lateral release. She highlighted challenges like recurrence and fixation loss but emphasized that Lapidus remains essential for certain cases.<br /><br />Tom McDonald addressed revision MIS surgeries, focusing on understanding failure causes, patient communication, managing expectations, and shared decision-making. He stressed that revision surgery mastery requires diagnosis, decision-making, technique, and communication skills.<br /><br />The panel discussed first tarsometatarsal joint instability assessment, preservation of subchondral bone, and fixation strategies, with consensus that some degree of instability does not necessarily lead to arthritis, though it may contribute to recurrence or hardware issues. They noted the need for further research and acknowledged MIS’s evolving role in primary and revision hallux valgus surgery.

Asset Subtitle

Moderator: Peter Lam, MD, MBBS

Historical Perspective on MIS Hallux Valgus
Joel Vernois, MD

PelCO
Jorge Javier del Vecchio, MD

Soup to Nuts HV
David Gordon, MD, MBChB, MRCS

MIS Lapidus
A. Holly Johnson, MD

Revision
Thomas A. McDonald, MD

Questions/Case Discussion

Keywords

minimally invasive surgery

hallux valgus correction

foot and ankle surgery

MIS osteotomies

MICA fixation technique

percutaneous intraarticular chevron osteotomy

distal osteotomies

Lapidus procedure

revision MIS surgery

tarsometatarsal joint instability