Minimally Invasive Foot Surgery

What is Minimally invasive foot surgery?

Minimally invasive foot surgery is a type of surgery that is performed through a very tiny incision and needs little or no stitching. Surgeons introduce specially developed devices to complete the surgery through these incredibly small holes.

Interventions are performed through these small incisions, which have limited exposure to the surgical field and cause little or no harm to the surrounding tissue. As a result, minimally invasive foot surgery allows us to better regulate and anticipate a patient's recovery and success.

Foot and ankle orthopedic surgeons employ minimally invasive foot surgery (MIS) to treat particular foot and ankle disorders with extremely small incisions. Because of its claimed speedier recovery time, lesser scars, and lower postoperative analgesic usage, this procedure has gained popularity among surgeons and patients alike.

Minimally invasive foot surgery (MIS) uses very small incisions to treat foot and ankle diseases and deformities. Your foot and ankle orthopedic surgeon will use sophisticated devices to cut bones under X-ray guidance and introduce screws via extremely small incisions during these operations.

Minimally invasive surgery has several advantages over standard surgery, including faster recovery, fewer scars, and less stiffness. The biggest downside is that your surgeon will need more training and practice to feel comfortable conducting these procedures without the conventional open visualization.

Dr. Morton Polokoff introduced minimally invasive surgery in 1945, developing these procedures as a system of subdermal surgery with very small instruments. Further surgical developments have led to the state-of-the-art techniques that are now conducted by surgeons, making minimally invasive surgery significantly safer and more comfortable for patients.

However, only qualified surgeons should undertake these minimally invasive foot procedures. They only get these particular surgical abilities through lengthy training, ongoing education, seminars, and fellowship within the field of minimally invasive foot surgery.

 

What conditions can be treated by Minimally invasive foot surgery?

Minimally invasive foot surgery may be used for a variety of foot surgeries, including a bunionectomy, or surgery to repair bunions. Bunions are a frequent foot disorder in which a bony lump protrudes from the outside base of the big toe.

Minimally invasive foot surgery can also be used to treat other foot and ankle disorders that include:

• Bunionettes (bunions, but on the tiny toe instead of the large toe).
• Hammer toe (curled toe caused by a bend in the toe's middle joint).
• Other toe deformities.
• Joint arthritic bump removal.
• Heel bone spur removal.
• Flat foot correction.
• High arch correction.
• Removal of abnormal bone growth in diabetics to avoid underfoot ulcers.

Anyone suffering from one of these foot diseases is eligible for minimally invasive foot surgery. It is especially useful for people who have skin or blood supply difficulties in their feet and cannot have open surgery owing to wound healing concerns.

 

What are the advantages of Minimally invasive surgery over open technique?

There are several advantages to minimally invasive foot surgery, including:

• There is less soft tissue harm with less invasive foot surgery. In contrast to traditional open surgery, which employs large incisions that may cause greater harm to soft tissue, minimally invasive surgery uses considerably tiny incisions that disrupt less tissue and result in a faster recovery period.
• Studies have shown that patients who have minimally invasive surgery experience less pain than people who undergo standard surgery. As a result, patients undergoing minimally invasive surgery require fewer painkillers.
• Surgery timings for minimally invasive foot surgery techniques are generally quicker than those for standard open operations due to the tiny incision.
• Fewer anesthetics, more qualified patients - Because of the nature of minimally invasive foot surgical methods, patients frequently remain awake during surgery after receiving thorough local anesthetic to the foot region, minimizing the need for general anesthetic. As a result, throughout these operations, the foot just falls asleep. This opens up surgery options for people who were previously thought to be at risk for regular operations owing to medical history.
• Less scarring - Because of the tiny incisions used in minimally invasive foot operations, scars left by these treatments are smaller and less apparent. Scars that do occur frequently have a less jagged edge than those produced by standard open operations.

 

How does healing differ after Minimally invasive foot surgery?

The soft tissues in the foot are less traumatized during minimally invasive foot surgery. This means that the soft tissues will heal faster than they would after open foot surgery. Following minimally invasive surgery, there will be less bruising, edema, and stiffness, and the foot will seem more normal.

If the bones are cut, whether during minimally invasive or open foot surgery, they will require the same amount of time to recover. Furthermore, regardless of the kind of surgery, the foot will need to be elevated for a period of time following surgery, depending on the procedure.

Anyone undergoing foot surgery, whether minimally invasive or open foot surgery, will require rest and recuperation afterward. Patients who have undergone minimally invasive surgery, on the other hand, often report that they can walk and move around more readily in the early stages of recovery due to reduced edema and stiffness.

Although recovery following minimally invasive foot surgery is generally faster than from open foot surgery, it is best to think of recovery as "easier" rather than "quicker." This is especially true if the procedure involves bone cutting (which depends on your foot condition and the type of surgery being carried out).

 

What is required before Minimally invasive surgery?

Importantly, not all patients are suitable candidates for minimally invasive surgery, and not all doctors conduct it. Whether you are interested in the operation, see a foot and ankle orthopedic surgeon with minimally invasive surgery skills to determine if you are a good candidate.

Physical examination of your foot will be used for preoperative evaluation. including observing how you stand and evaluating weight-bearing X-rays of your foot. If you have a severe deformity that is accompanied by additional foot issues that necessitate surgical intervention, you may require a more complex, open treatment. To determine which option is ideal for you, consult with your orthopedic foot and ankle surgeon. 

 

Minimally invasive bunion surgery

Because minimally invasive bunion surgery is the most commonly conducted minimally invasive foot surgery, we will use it as an example of minimally invasive foot surgery.

A metatarsal osteotomy or bunionectomy is the corrective treatment for a bunion. There are several procedures, but they all include removing the bones and relocating them with metal screws to straighten the big toe and decrease the side of the foot hump.

A bunion (hallux valgus) is a disorder in which the base of your big toe protrudes on the inside of your foot. This bump happens as your foot alignment shifts, causing your big toe to shift nearer your smaller toes. The pressure from the bump on your shoe, as well as your big toe rubbing against your second toe, might cause pain. Furthermore, discomfort in the ball of the foot might arise as a result of the big toe's improper alignment.

Bunion removal surgery should not be performed just for aesthetic reasons. It is used on patients whose daily lives are disrupted by discomfort and difficulties wearing shoes, even after they have tried broader, more comfortable shoes.

If you've tried larger shoes, cushioning, toe spacers, and other therapies but are still experiencing pain that limits your activities, you may be a candidate for surgical bunion repair. Bunion surgery has always been unpleasant and time-consuming. Some patients, however, may benefit from newer, less intrusive treatments that provide considerable advantages.

Any patient with a bunion might benefit from minimally invasive bunion surgery. Patients who are healthy, active, and responsible are great candidates for the surgery. Patients with big toe arthritis may require different procedures. Some people may not be suitable candidates for minimally invasive bunion surgery, depending on the procedure used.

Patients who smoke, as with any bone surgery, are at risk of delayed bone healing, but smoking is not an absolute contraindication. Patients with osteopenia or osteoporosis may require a more restrictive postoperative course and/or immobilization. Diabetic neuropathy patients should be closely monitored and should be immobilized. Non-adherent patients always have issues following a bunionectomy.

 

Technique of minimally invasive bunion surgery

In minimally invasive bunion surgery, the bone is sliced with a burr rather than a saw. Instead of the large incisions used in traditional procedures, the cuts can be done "percutaneously," or by small incisions made through the skin of the foot.

Because fewer soft tissues (skin, muscle, joint capsule, etc.) are damaged by avoiding extensive incisions, the foot is less swollen and uncomfortable following surgery. This enables instant weight bearing, faster bone repair, and a sooner return to normal activity levels. Depending on the severity of a patient's bunion, the surgeon undertakes two methods of minimally invasive bunion correction:

• Surgeons employ the PECA, or Percutaneous Chevron Akin, procedure for mild to severe bunions. This entails cutting the first metatarsal bone and relocating the big toe bone to restore the alignment.
• Surgeons use the (minimally invasive, or MIS) Percutaneous Lapidus method for severe bunions. This entails moving and fusing a joint closer to the arch, as well as cutting the toe bone. This procedure, like the PECA approach, provides for early weight-bearing with less pain, a better aesthetic result, and a speedier return to work and athletics.

Over a patient's lifetime, the recurrence rate (a bunion returning after surgery) is around 20%. Most individuals tolerate a modest bunion recurrence well. Significant bunion recurrences that cause difficulties and necessitate further treatment are uncommon.

Recurrence is possible if the bunion is not completely treated at the time of surgery or if the incorrect bunion technique is employed. It may also occur if individuals do not strictly follow the postoperative instructions. Overcorrection ("hallux varus") is also a possibility, though it is far less prevalent. Recurrence or overcorrection may necessitate a second procedure (revision surgery). 

 

What happens after Minimally invasive foot surgery?

MIS postoperative care is quite unique and distinct from open surgery. Percutaneous surgery success is dependent on the postoperative period, which is sometimes disregarded by some surgeons. This is seen as a continuation of the operation. Neglecting the fundamental guidelines of MIS, including postoperative care, raises the likelihood of complications, lowering the final outcome.

 

Postoperative pain:

Because there is little foot manipulation, pain during minimally invasive foot surgery is minor. Following surgery, patients are given a nerve block that numbs the foot for 24 hours. Patients are also advised to take ibuprofen and acetaminophen for two to three days following surgery. Less than half of the patients require heavier medicine, and those who do require it take less than five tablets. 

 

When can I can return to my routine activities following Minimally invasive surgery?

The first two weeks after surgery are critical, and you should carefully follow your surgeon's instructions.

You will be equipped with a special surgical post-op shoe following PECA surgery, and you will be able to bear full weight practically immediately once the complete sensation in your foot has been returned. You will need to limit your activities and keep your foot elevated around 50% to 80% of the time for the first two weeks following surgery to reduce swelling and allow the wounds to heal. For the first two weeks, patients should keep off their feet and relax. It is usually suggested that you maintain the surgical region elevated for 80 percent of the first week and 50 percent of the second week.

You may be given a bunion splint after the first two weeks to keep the postsurgical alignment. During this period, you can gradually increase your walking and resume your usual daily activities. It is critical that you keep your foot elevated when sleeping for the first two weeks after minimally invasive foot surgery. Moving your calf muscles and wiggling your toes on a regular basis is also beneficial during this period.

Most people may resume their normal activities six weeks following surgery, but your surgeon will advise you based on your specific circumstances. Depending on the kind of treatment, you will be able to put weight on your foot within 24 hours (for PECA surgery) or two to four weeks (for the minimally invasive Lapidus surgery).

Unless they work from home, most patients take at least two weeks off from work, and longer if they must commute by public transit or drive. You may also aid your recovery by avoiding standing on your foot or allowing your foot to hang down when sitting or lying for more than 15 to 20 minutes at a time during the first two weeks after surgery. 

 

Full recovery:

Full recovery from any sort of foot surgery is dependent on the surgical approach and the disease being treated. Some operations, like as bunionectomy, may necessitate the use of a specific post-operative shoe for a few weeks. The total recuperation time is primarily determined by whether you have minimally invasive or open surgery.

Patients undergoing minimally invasive surgery may usually walk in regular sneakers six weeks after the PECA procedure and eight weeks after the MIS Lapidus operation (compared to 10 to 12 weeks after open surgery). Activity is gradually increased as the patient tolerates it. Running and jumping are prohibited for 12 weeks, but cycling, spinning, walking, and swimming are permitted as the patient tolerates.

You will be required to wear the special post-op shoe for approximately six weeks following surgery. Depending on your level of swelling and comfort, you should be able to start wearing conventional footwear after around six weeks. By three months postoperatively, the majority of patients were able to wear flat, comfortable shoes, as well as all sneakers and boots. Patients may endure edema for 6 to 12 months following surgery, which may limit their ability to wear high-fashion shoes.

This varies by individual, but if further foot surgery, such as hammertoe repair, has been performed, the time it takes to go back into standard shoes can be extended. You should be able to wear a standard shoe around 10 to 12 weeks following surgery, and you can gradually increase your activity level as tolerated. 

 

What are the complications of Minimally invasive foot surgery?

The vast majority of patients are really satisfied with their minimally invasive surgery. The results are quite favorable if the patient attentively follows the postoperative recommendations.

Although rare but minimally invasive foot surgery, like other surgeries, is associated with some risks. The hazards of minimally invasive surgery are similar to those of standard, open operations, while the chances of infection and wound healing difficulties may be decreased with minimally invasive surgery due to the tiny incisions.

While the small incisions used in minimally invasive surgery may make it easier to injure invisible tissues such as nerves and tendons, research has not revealed a greater occurrence of these injuries. With proper technique and surgeon skills, laparoscopic operations may even be less risky than open surgeries. More study on these techniques is needed to establish their risks and advantages in comparison to more standard surgical approaches.

Delayed bone healing is possible after any foot surgery, although it is uncommon. This possibility is greater if people do too much too quickly (against their doctor's advice) and/or have health problems that can interfere with bone recovery.

Following surgery, some numbness around the incisions may be felt. This usually clears up in three to six months. It may persist in rare circumstances.

Bleeding, blood clots, and anesthetic risks are other uncommon problems. Recurrence of the bunion (the bunion reappearing) is possible following any kind of bunion repair, and this risk is not known to be enhanced in people who have minimally invasive bunion correction surgery. 

 

Conclusion 

Minimally invasive foot surgery (MIS) treats foot and ankle disorders and abnormalities using extremely tiny incisions. During these surgeries, your surgeon will utilize advanced instruments to cut bones under X-ray guidance and insert screws through very small incisions.

Minimally invasive foot surgery is used by foot and ankle orthopedic surgeons to address certain foot and ankle conditions with tiny incisions. This surgery has acquired favor among practitioners and patients because of its reported faster healing time, less scarring, and decreased postoperative analgesia.

There are various advantages of minimally invasive surgery over traditional surgery, including speedier recovery, less scarring, and less stiffness. The main disadvantage is that your surgeon will require additional training and practice to feel comfortable doing this type of surgery.

MIS of the foot can be utilized for a wide range of foot procedures, including bunionectomy, or bunion repair surgery. Bunions are a common foot condition characterized by a bony lump protruding from the outer base of the big toe.

While recuperation from minimally invasive foot surgery is often faster than recuperation from open foot surgery, it is preferable to consider the recovery process as easier rather than earlier. This is especially true if the treatment involves the removal of bone (osteotomy).

The effectiveness of percutaneous surgery is reliant on the postoperative phase, which is occasionally overlooked by certain surgeons. This is thought to be a continuation of the surgery. Neglecting the essential MIS recommendations increases the chance of complications and worsens the final result.

The extent of recuperation from any type of foot surgery is determined by the surgical strategy and the illness being treated. Some procedures, such may need the use of a special post-operative shoe for a period of time. As the patient tolerates it, activity is slowly increased. Running and bouncing are restricted for 12 weeks.

The majority of patients were able to wear flat, comfortable shoes, as well as all sneakers and boots, three months after surgery. Patients may experience edema for 6 to 12 months after surgery. The great majority of patients are quite pleased with the results of their minimally invasive surgery. If the patient carefully follows the postoperative instructions, the results are fairly positive.