Is MIS the Gold Standard in Foot and Ankle Surgery?

Q: Can you briefly comment on the role minimally invasive surgical (MIS) procedures are playing in foot and ankle surgery? 

MIS applications in foot and ankle surgery are continually evolving, noted Noman Siddiqui, DPM, FACFAS.

“We are finding new applications of MIS methods to perform procedures that were done traditionally open through a much larger incisional/dissection approach,” he said.

As Dr. Siddiqui noted, applications of MIS include osteotomies/fusions/repair and transfer of tendons. He said the biggest role of MIS has been an earlier rehabilitation timeframe and potential decreased use of narcotic medication for postop pain control, calling this “a welcome aspect to our patient population.”

Q: Do you feel MIS is truly the new gold standard?   

Dr. Siddiqui cautioned against referring to anything broadly as a gold standard, saying “there are too many patient-related nuances and much of what is considered gold standard might be based on selection and surgeon bias based off the prevailing technique of a certain time.”

Instead, Dr. Siddiqui advocated thinking in terms of better or best practices tailored to the patient and surgeon’s skill set.

MIS hallux valgus surgery has been a part of Dr. Siddiqui’s practice since 2012, as he wrote in Podiatry Today in 2014.¹ “For me, I cannot imagine doing an open procedure for a nonarthritic, primary bunion deformity, irrespective of radiographic parameters,” said Dr. Siddiqui, the Chief of the Division of Podiatry at the International Center for Limb Lengthening at Rubin Institute for Advanced Orthopedics at Sinai Hospital of Baltimore.

Dr. Siddiqui noted that in his observation, “the era of bashing MIS approaches for hallux valgus and beyond for corrective foot and ankle surgery is gone” and said if there is a gold standard, it is doing good musculoskeletal foot and ankle surgery, whether open or MIS.

Q: What do you feel is the most important thing for surgeons to know about MIS foot and ankle surgery? 

Dr. Siddiqui noted that surgeons should regard MIS as an alternative to open methods, requiring an expert understanding of anatomy. To be successful, he said one must have committed training and practice prior to applying these methods.
 
Reference
1. Siddiqui NA, LaPorta G. Emerging insights on minimally invasive hallux valgus correction. Podiatry Today. 2014;27(9):26–32.