Minimally invasive foot surgery: what is it and what are the gains and pitfalls?

Minimally invasive surgery (MIS) describes surgery performed using specialized equipment through small incisions. It includes a wide range of surgery such as arthroscopy as well as percutaneous soft tissue or bony corrective surgery. MIS has been associated with a high complication rate historically from a lack of understanding the importance of appropriate equipment, intraoperative imaging and appropriate fixation. These have been addressed with better instruments, better osteotomy techniques with internal fixation which have improved the outcomes of MIS. Recent systematic reviews comparing MIS with open surgery show similar outcomes with the added benefit of lower wound complication rate and shorter hospital stays in both the trauma and elective settings. Overall evidence is still relatively poor and long-term outcome studies are still needed. The main pitfalls with MIS include a steep learning curve as well as higher metal work removal rate compare to open techniques. There are also technical pitfalls especially when performing hallux valgus surgery.