Does MIS First MTP Fusion Have Benefits Over the Traditional Approach?

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My name is Brad Abicht, based out of Gundersen Health System in La Crosse, Wisconsin.
 
Can you share your experience with MIS first MTP fusion?
 
Yeah, regarding MIS approaches to arthrodesis of the great toe joint, again, I think this is an emerging concept. If you look at the literature, there's some international literature out there, but really no American literature. Up until recently, I had mentioned our study that we published in Foot and Ankle Surgery: Techniques, Reports and Cases back in December of 2023. This was really the first American study that addresses arthrodesis of the great toe joint through a percutaneous approach.
 
I'd also published a technique paper back in 2021 that goes over the technique for percutaneous arthrodesis of the great toe joint. These were both in Foot and Ankle Surgery: Techniques, Reports and Cases.
 
And I think they're really helpful, especially for surgeons that are kind of just getting into minimally invasive surgery or percutaneous techniques. And again, it's really up to the surgeon to decide if this is the right technique for their patient or what they're comfortable with. But I think there are some significant advantages to doing it through either an MIS or percutaneous technique over some of our more traditional open approaches.
 
What are the key differences between MIS and the traditional approach?
 
Yeah, some of the key differences I would highlight between percutaneous approach versus an open approach. Obviously, the incisions for percutaneous surgery are smaller. You end up having typically two or three very small mosquito bite–type incisions, which are very cosmetically pleasing and do raise a high patient satisfaction level. Patients really love seeing those tiny incisions. Through this approach, we've also allowed patients to bear weight on their foot immediately. Basically, just tell them not to have a propulsive-type gait and raise a high patient satisfaction level. we keep them in a surgical shoe for about four to six weeks, which makes their postoperative recovery process a lot easier than some of our traditional techniques.
 
Typically, they also have less postoperative pain because we're not doing the same amount of dissection of all the soft tissues around the great toe joint. This leads to a little bit less pain and swelling for them postoperatively and I would say those are probably the biggest advantage. compared to some of our open approaches.
 
Is there any research to guide surgeons in learning more about these options?
 
The most common research that would be out there right now, there's a couple publications in Foot and Ankle Surgery: Techniques, Reports and Cases that our group here had done. One is just a surgical technique publication that goes over how to do the procedure. There's an associated video with that.
 
We also just recently put out a retrospective review on our case series here that we had done on percutaneous arthrodesis of the great toe joint.
 
That involved 18 patients and really demonstrated that this is an effective technique and can be safe for patients and does not cause any overshortening of the first ray. That was another thing that we looked at with the study. Currently, our series is up to roughly about 25 patients, and in the publication we had 18 total that we had published on.
 
So it does continue to grow, and I'm excited for the future to see what other groups and what other publications come out on these techniques.