CME OnDemand: Small Incisions, Big Results: MIS to the MAX-Symposium 2: The Rest of the Forefoot: What No One Wants to Deal With

Video Transcription

Video Summary

The session focuses on minimally invasive surgery (MIS) techniques for complex forefoot conditions like hammertoes, bunionettes, metatarsus adductus, and hallux rigidus. Dr. Edward Haupt highlights MIS for hammertoes, advocating for accurate joint-level diagnosis and bone cutting techniques using closing wedge osteotomies for deformity correction, often supplemented by limited soft tissue balancing or fusion in rigid cases. He emphasizes the stability challenges of bicortical osteotomies and his preference for suture fixation.<br /><br />Dr. Thomas Harris discusses MIS for bunionettes and distal metatarsal mini-osteotomies (DMMOs), noting easier surgeries, no fixation in many cases, early weight bearing, and reduced stiffness versus open techniques. He stresses careful surgical angles and managing complications like nonunion.<br /><br />Elizabeth Martin reviews metatarsus adductus correction with distal and proximal percutaneous osteotomies or fusion, stressing patient selection, combination with other procedures, and the need for strapping to mitigate recurrence. She notes limited literature and advocates individualized approaches based on severity.<br /><br />Dr. Thomas Lewis presents MIS decompressive osteotomy for hallux rigidus, acknowledging limited evidence but advocating the Waterman Green osteotomy combined with cheilectomy and Moberg osteotomy to improve dorsiflexion and pain while preserving the joint.<br /><br />Alex Peterson covers minimally invasive dorsal cheilectomy with arthroscopy, highlighting small incisions, quicker recovery, and similar outcomes to open surgery but noting higher complication rates possibly due to learning curves. He stresses thorough bone debris removal and nerve protection techniques.<br /><br />Throughout, the panel discusses technical pearls, patient selection, fixation choices, and management of complications, emphasizing that MIS offers promising functional improvements for challenging forefoot deformities, but further evidence and surgeon experience are needed.

Asset Subtitle

Moderator: Rebecca A. Cerrato, MD

Hammertoes & Crossover Toes
Edward T. Haupt, MD

DMMO & Bunionette
Thomas G. Harris, MD

Metatarsus Adductus: TMT Fusion or Basilar Osteotomy
Elizabeth A. Martin, MD

Hallux Rigidus: Osteotomize the MT to Offload the Arthritis
Thomas L. Lewis, MBChB, MRCS

Cheilectomy with Scope
Alexander B. Peterson, MD

Questions/Case Discussion

Keywords

minimally invasive surgery

forefoot deformities

hammertoes

bunionettes

metatarsus adductus

hallux rigidus

osteotomy techniques

soft tissue balancing

surgical complications