It involves making a small incision roughly one centimeter on either side of the heel. A surgical scope is then placed in one incision and a small surgical hook is placed in the other incision. While fully visualizing the plantar fascia with the camera, the surgeon uses the hook to cut a portion of the fascia. The hook and the camera are then removed, and the incisions are closed with one or two stitches.
During recovery, the cut portion of the fascia lengthens about one inch and heals in this position. If you have a foot or ankle injury or condition that needs surgery, our podiatrist will let you know if you are a candidate for minimally invasive foot and ankle surgery. Arthroscopic Surgery of the Foot Minimally Invasive Foot Surgery Arthroscopy can be used to treat joint problems within the bones of the feet and toes.
Arthroscopic Ankle Surgery Minimally invasive ankle surgery is used to treat a variety of conditions, including: Ankle arthritis Ankle fractures Ankle instability Ankle impingement inflammation of the bone or soft tissue at the front or back of the ankle Arthrofibrosis scar tissue within the ankle Infection of the joint space Loose cartilage, bone, and scar tissue Osteochondral defects damaged cartilage and bone in the ankle joint Synovitis inflammation of the soft tissue lining of the ankle joint Generalized ankle pain The advantages of arthroscopic surgery are less pain and stiffness, fewer complications, and — since the incisions are small — a faster recovery period.
Endoscopic Plantar Fasciotomy EPF EPF is a minimally invasive surgical alternative for chronic plantar fasciitis, an inflammation of the thick band of tissue that connects the heel bone to the toe.
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Currently, EPF is the most common surgery performed for plantar fasciitis. Request an Appointment. All Rights Reserved. Crossover 2 nd toe deformity with subluxation at the MTPJ as seen clinically and radiographically. Note the concomitant hallux valgus deformity. The procedures performed were based on the principles and techniques described in Maffulli and Easly [ 3 ]. A total of patients 15 male, female underwent MIS surgery for digital deformity during this period.
Within the cohort, patients were categorised as ASA 1 The majority of comorbidities reported were controlled hypertension, hyperlipidaemia, asthma, osteoporosis and osteoarthritis. Five patients had Diabetes Mellitus DM. The latter two patients had a history of apical ulceration affecting the digit undergoing surgery. Five patients disclosed a history of smoking tobacco. Local blocks were performed using either 0.
Distribution of procedures and adverse outcomes. Most commonly pain, infection, neurovascular compromise, delayed healing, bony non-union, post operative wound infection and vascular impairment requiring Kirschner wire removal and medical complications such as deep vein thrombosis DVT [ 15 - 19 ].
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The results of this audit indicate significantly lower complication rates with MIS techniques. Superficial surgical site infection developed in one patient, which resolved following a single course of oral antibiotics. This represented a total infection rate of 0. This patient had well controlled Type II DM, the procedure was performed in a hospital setting and antibiotic prophylaxis was administered at the time of surgery.
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The diabetic population in this study represented just 2. Higher rates of infection would have been expected with a greater percentage of patients with DM particularly if complicated by peripheral neuropathy [ 21 ]. The under correction rate in this audit was 0. Revision osteotomies were performed as well as appropriate soft tissue release to achieve rectus alignment.
The post-operative management was as described in the methods section. The revision rates in this audit compare favourably to those of open digital deformity correction, which have been reported to range between 2—7. Many papers investigating MIS techniques report the reduced potential for neurovascular complications [ 3 - 6 ]. No patients in this audit developed neurological or vascular compromise.
This is consistent with previous anecdotal claims that MIS techniques are associated with fewer iatrogenic complications, most notably involving the skin and vessels [ 23 ]. No blanching or cyanosis was exhibited in the immediate post operative period following MIS which does occur to varying degrees following open surgery and Kirschner wire fixation.
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Although as part of our study we did not specifically assess post-operative pain levels, during clinical review 2 patients 0. The inclusion of variations in comorbidity demonstrated by the ASA and inclusion of patients with diabetes mellitus and smokers was anticipated to result in higher complication rates. In this cohort, comorbidities did not translate to increased complication rates. Furthermore there was no increase in complications with the performance of additional procedures required to reduce complicated deformities in the digits. Intraoperative conversion to open repair was not required in this cohort despite correction of complex digital deformities such as overlapping and crossover toes.
Appreciation for traditional surgical approaches and three-dimensional anatomy are paramount when attempting digital deformity correction with MIS techniques [ 3 - 6 ] particularly in the absence of fluoroscopy.
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The authors advocate structured training in MIS techniques of the foot and ankle after a sound background and experience with open surgical techniques. Despite the limitations of this audit, promising results have been illustrated in relation to the fundamental safety of performing minimal incision surgery in the digits.
The authors advocate future research to evaluate the nature and extent of digital surgery that can be performed via MIS techniques. Ideally such research should be prospective, long term and comparative to open techniques. It should include important clinical information such as surgeon learning curve, pre- and post-operative clinical outcome data using validated tools, union rates with radiographic data, pre and post-operative clinical images and a full cost benefit analysis. Ultimately the development of validated treatment algorithms is required in order to guide clinical decision making.
This audit has illustrated that performing MIS to address simple and complex digital deformity results in low complication rates.
Further studies investigating the effectiveness of these techniques are warranted and should evaluate long term patient reported outcome measures, as well developing treatment algorithms to guide clinical decision making. Minimally invasive surgery. Australian Council of Healthcare Standards.
Minimally Invasive Surgery of the Foot and Ankle : Nicola Maffulli :
National Research Ethics Service. Local anaesthesia. General anaesthesia. Superficial venous plexus filling time. American Society of Anesthesiologists. Australasian College of Podiatric Surgeons. Metatarsophalangeal joint. Diabetes mellitus. Deep vein thrombosis. This article is published under license to BioMed Central Ltd. Minimally invasive surgery for pedal digital deformity: an audit of complications using national benchmark indicators. Journal of Foot and Ankle Research 8 Abstract Background There is increasing global interest and performance of minimally invasive foot surgery MIS however, limited evidence is available in relation to complications associated with MIS for digital deformity correction.
Methods A prospective clinical audit of patients who underwent MIS to reduce simple and complex digital deformities was conducted between June and June Results The surgical complications included 1 superficial infection 0. Conclusion This audit has illustrated that performing MIS to address simple and complex digital deformity results in low complication rates compared to published standards.
Clinical audit Minimally invasive surgery Percutaneous Hammertoe Complications. Inclusion criteria All patients who underwent minimally invasive procedures by a single surgeon MG for lesser toe pathology digital deformity over a two year period June until June were included. Data collection Vascular status was assessed immediately post operatively using clinical signs of colour and temperature as well as superficial venous plexus filling time SVPFT.
These indicators have been developed and validated utilising the ACHS clinical indicator program [ 11 ]. Complications related to the indicators were entered into the ACPS database as part of compliance with national audit. Table 1 ACPS surgical audit indicators.
Figure 1 Simple digital deformity pre-operative. Surgical procedures in this group involved those described for simple deformity as well as percutaneous reconstructive procedures at the metatarsophalangeal joint level. Examples include distal metatarsal osteotomies and soft tissue releases at the MTPJ. Figure 2 Complex digital deformity pre-operative.
A total of digits were operated on out of the patients included in the study. Of these, 84 patients underwent surgery on multiple digits. Table 2 Distribution of procedures and adverse outcomes. Minimally invasive arthrodesis of the first metatarsophalangeal joint for hallux rigidus. Foot Ankle Surg. Minimal incision surgery: a plastic technique or a cover-up?
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