MIS Technique for Interphalangeal Arthrodesis and Phalangeal Osteotomies

Q: What are your most important pearls for minimally invasive surgery (MIS) for interphalangeal arthrodesis?

A: As Dr. Saysoukha notes, arthrodesis of the interphalangeal joint is performed from a medial or lateral approach and the burr is inserted into the joint. She suggests making sure to use burrs that are less thermogenic with irrigation attached. K-wires or cannulated screws can be used for internal fixation.

Q: What are your most important pearls for MIS for phalangeal osteotomies?

A: Closing wedge osteotomies of the proximal and/or middle phalanges can correct sagittal or transverse deformities, says Dr. Saysoukha. These osteotomies are performed from a plantar approach. As she notes, bicortical osteotomies can correct complex hammertoe deformities and will shorten the toe and can be performed from a medial or lateral approach. Dr. Saysoukha says the surgeon typically does not need internal fixation with this approach.

Q: What is the future of MIS in podiatric surgery?

A: Since the 1990s, Dr. Saysoukha says there have been many applications of MIS in podiatric surgery, including bunion and hammertoe corrections. Today, she notes MIS approaches have been added to limb salvage and fusions of the midfoot and rearfoot joints. Newer studies worldwide are showing that MIS offers many advantages since less thermogenic burrs now exist and surgical techniques have been refined, according to Dr. Saysoukha. As she asserts, MIS is more reproducible and safer compared to first generation techniques.
 
“I have personally seen, and believe the profession will continue to see, innovations and advances towards having MIS approaches as a viable alternative to open foot and ankle surgeries,” says Dr. Saysoukha.