{"title":"Evolution of minimally invasive surgery (MIS) techniques in forefoot deformity corrections.","authors":"Chin Yik Tan, Gowreeson Thevendran","doi":"10.1007/s00264-026-07060-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To review the historical evolution and technical progression of minimally invasive surgery (MIS) in forefoot deformity corrections, tracing its development from early medical concepts and general surgery milestones to modern, highly specialized foot and ankle interventions.</p><p><strong>Methods: </strong>An extensive electronic search of the medical and historical literature was performed and complemented by manual review of scientific sources. Historical reports describing the origins of minimally invasive techniques, the evolution of surgical instrumentation, and advancing treatment strategies for forefoot deformities were critically analysed within their scientific and chronological contexts.</p><p><strong>Results: </strong>The history of forefoot MIS represents a continuous process of conceptual evolution. The procedure's trajectory mirrors the disruptive history of laparoscopic surgery, transitioning from early enthusiasm and high complication rates in the United States to a European-led renaissance grounded in strict anatomical landmarks and technological advancements, such as the Shannon burr and image intensifiers. For hallux valgus, the procedure has progressed through four distinct generations distinguished by specific osteotomy and fixation strategies, moving toward true three-dimensional deformity correction. In the treatment of hallux rigidus, MIS provides effective joint-preserving options through percutaneous cheilectomies and decompressive osteotomies, as well as joint-sacrificing arthrodesis. For lesser toe deformities, treatment paradigms have shifted toward more standardised classification, and utilizing hardware-free metatarsal and phalangeal osteotomies that rely on strict postoperative weight-bearing to achieve optimal anatomical alignment.</p><p><strong>Conclusions: </strong>The historical maturation of forefoot MIS illustrates a continuous refinement of surgical \"processes\" and hardware \"ingredients\" aimed at optimizing clinical outcomes. Understanding this evolutionary framework provides a crucial foundation for future innovations, including the integration of bioabsorbable implants, 3D-printed instrumentation, and artificial intelligence in foot and ankle surgery.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00264-026-07060-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To review the historical evolution and technical progression of minimally invasive surgery (MIS) in forefoot deformity corrections, tracing its development from early medical concepts and general surgery milestones to modern, highly specialized foot and ankle interventions.
Methods: An extensive electronic search of the medical and historical literature was performed and complemented by manual review of scientific sources. Historical reports describing the origins of minimally invasive techniques, the evolution of surgical instrumentation, and advancing treatment strategies for forefoot deformities were critically analysed within their scientific and chronological contexts.
Results: The history of forefoot MIS represents a continuous process of conceptual evolution. The procedure's trajectory mirrors the disruptive history of laparoscopic surgery, transitioning from early enthusiasm and high complication rates in the United States to a European-led renaissance grounded in strict anatomical landmarks and technological advancements, such as the Shannon burr and image intensifiers. For hallux valgus, the procedure has progressed through four distinct generations distinguished by specific osteotomy and fixation strategies, moving toward true three-dimensional deformity correction. In the treatment of hallux rigidus, MIS provides effective joint-preserving options through percutaneous cheilectomies and decompressive osteotomies, as well as joint-sacrificing arthrodesis. For lesser toe deformities, treatment paradigms have shifted toward more standardised classification, and utilizing hardware-free metatarsal and phalangeal osteotomies that rely on strict postoperative weight-bearing to achieve optimal anatomical alignment.
Conclusions: The historical maturation of forefoot MIS illustrates a continuous refinement of surgical "processes" and hardware "ingredients" aimed at optimizing clinical outcomes. Understanding this evolutionary framework provides a crucial foundation for future innovations, including the integration of bioabsorbable implants, 3D-printed instrumentation, and artificial intelligence in foot and ankle surgery.
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable.
The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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