Percutaneous and Minimally Invasive Foot Surgery

Foreword 1
Foreword 2
Contents
1: Introduction
1.1 Emergence of Percutaneous Surgery
1.2 What Is Percutaneous Surgery?
1.3 History of this Revolution
1.4 Growth of Percutaneous Surgery in France
1.5 Integrating Percutaneous Surgery into your Practice
1.6 Simple Technical Evolution or Radically Different Concept?
1.6.1 Technical Evolution in Conventional Surgery
1.6.2 Different Concept
1.7 Biomechanical Translation of this New Concept
1.7.1 Absence of Pain
1.7.2 Immediate Full-Plantar Weight-Bearing
1.7.3 Surgeon’s Technical Expertise
1.7.4 Technological Innovation
1.7.5 New Roles of Dressings
1.7.6 New Anatomical Work
1.8 Conclusion
2: Foot and Ankle Anatomy: An Interview with Pau Golano
References
3: Instrumentation and Devices
3.1 Scalpels
3.2 Elevators
3.3 Rasps
3.4 Powered Surgical Tool
3.5 Burrs
3.6 Fluoroscopy
3.7 Specialized Instruments
3.8 Materials for Postoperative Course
4: Geometric Fundamentals of the Hallux Valgus and Surgical Options
4.1 Introduction
4.2 Geometry
4.2.1 Planning on AP View
4.2.2 Planning on Lateral View
4.2.3 Planning in Frontal Plane
4.3 Surgical Application
4.3.1 Geometric Characterization of the Chevron Osteotomy
4.3.2 Superior Cut
4.3.3 Inferior Cut
4.3.4 Relative Displacement of Bone Segments
4.4 Practical Consequences
4.5 Conclusion
5: Principles of Mechanical Stability for the Surgical Correction of Forefoot Deformities
5.1 Introduction
5.2 Complying with Standard Criteria
5.3 Surgical Indication
5.4 Architectural Correction
5.5 Immediate Mechanical Stability
5.6 Psychological Considerations
5.7 Conclusion
6: Gravity and Growth
6.1 Introduction
6.2 Mechanoreceptors: The Starting Point
6.2.1 Bone Cellular Organization
6.2.2 Intracellular Transmission: Cytoskeleton and Extracellular Matrix
6.2.2.1 In Animals that Have a Bony Skeleton
6.2.2.2 In Plants
6.2.3 Summary
6.3 Translation by Physical Elements
6.3.1 Physical Properties
6.3.1.1 Young’s Modulus (E)
6.3.1.2 Second Moment of Area (SMA) (Iz)
6.3.1.3 Calculation of Deflection
6.3.2 Elements Modifying Young’s Modulus
6.3.2.1 Hydroxyapatite and Animal Collagen
6.3.2.2 How Plants Make a Composite Material
6.3.2.3 Change in Orientation of Trabecular Bone
6.3.3 Elements Modifying the Second Moment of Inertia
6.3.3.1 Increase in Diameter
6.3.3.2 Compromise Between a Full and Hollow Tube
6.3.3.3 Ovalization of the Bone’s Cross-Section
6.3.4 Elements Modifying both Parameters
6.3.5 Impact of Frequency of Stress Application
6.3.6 Summary
6.4 Conclusion
7: Exostectomy
7.1 Introduction
7.2 Technique
7.3 Indications
7.4 Dangers
8: Arthrolysis of the First Metatarsophalangeal Joint
8.1 Introduction
8.2 Surgical Technique
8.3 Success Criteria
8.4 Risks
8.5 Indications
Reference
9: Reverdin-Isham Osteotomy
9.1 Principles
9.2 Surgical Technique
9.3 Indications and Results
9.4 Risks and Complications
Reference
Further Reading
10: Minimally Invasive Chevron Osteotomy
10.1 Introduction
10.2 Patient Positioning
10.3 Surgical Technique
10.3.1 Skin Incision
10.3.2 Arthrolysis
10.3.3 Metatarsal Osteotomy
10.3.4 Correction Checks
10.3.5 Fixation
10.3.6 Additional Procedures
10.3.6.1 Akin Osteotomy
10.3.6.2 Lengthening of Extensor Mechanism
10.4 Closure and Dressing
10.5 Postoperative Course
References
11: Hallux Valgus Correction via Distal Metaphyseal Osteotomy
11.1 Introduction
11.2 Etiology
11.3 Evaluation
11.3.1 Clinical Evaluation
11.3.2 Radiographic Evaluation
11.4 Surgical Correction
11.5 Dorsal Locking Plate Fixation in Distal Metatarsal Osteotomy
11.6 Authors’ Technique
11.7 Postoperative Care
11.8 Discussion
References
12: Minimally Invasive Scarf Osteotomy
12.1 Introduction
12.2 History
12.3 Anatomy
12.3.1 Vascularization of the First Metatarsal Head
12.3.2 Three Faces of the Metatarsal
12.4 Surgical Technique
12.4.1 Release
12.4.2 Surgical Exposure
12.4.3 Osteotomy Cuts
12.4.4 Displacement
12.4.5 Fixation
12.4.6 Final Steps
12.4.7 Postoperative Care
12.5 Displacement Options
12.5.1 Lateral Translation
12.5.2 Lowering
12.5.3 Distal Metatarsal Articular Angle Correction
12.5.4 Shortening
12.5.5 Supination
12.5.6 Elevation
12.5.7 Combinations
12.6 Complications
12.7 Discussion
12.8 Conclusion
References
13: Minimally Invasive Bevel Osteotomy of First Metatarsal without Fixation
13.1 Introduction
13.2 Surgical Technique
13.2.1 Lateral Release
13.2.2 Incisions
13.2.3 Metatarsal Osteotomy
13.2.3.1 Bone Translation
13.2.4 Bone Graft
13.2.4.1 Preparing the Bone Graft
13.2.4.2 Preparing the Graft Implantation Site
13.2.4.3 Inserting the Graft
13.2.4.4 Phalangeal Osteotomy
13.3 Conclusion
References
14: Percutaneous Correction of Mild to Severe Hallux Valgus Defomity: The Evolution and Current Concepts of the PECA Technique
14.1 Introduction
14.2 Evolution of the PECA Technique
14.3 Indications
14.4 Technique and Concepts
14.4.1 Setup and Imaging
14.4.2 Incisions
14.4.3 First Metatarsal Osteotomy
14.4.4 Guide Wire and Screw Positioning
14.4.5 Akin Osteotomy
14.4.6 Medial Eminence and Metatarsal Shaft Corner Resection
14.4.7 Lateral Release
14.4.8 Wound Closure and Dressings
14.5 Postoperative Instructions
14.6 Outcomes
14.7 Cases
14.8 Summary
References
15: Percutaneous Extra-Articular Reverse-L Chevron (PERC)
15.1 Introduction
15.2 Surgical Technique
15.2.1 Materials
15.2.2 Surgical Approaches
15.2.2.1 First Approach
15.2.2.2 Second Approach
15.2.2.3 Third Approach
15.2.3 Patient Positioning
15.2.3.1 First Step: Metatarsal Osteotomy
15.2.3.2 Second Step: Lateral Release (Optional)
15.2.3.3 Third Step: Proximal Phalanx Osteotomy (Optional)
15.2.4 Exostectomy (Rarely Done)
15.3 Postoperative Course
15.4 Complications
15.5 Conclusion
References
16: Percutaneous Osteotomy of the First Metatarsal Base
16.1 Introduction
16.2 Surgical Technique
16.3 Postoperative Course
References
17: Conservative Surgical Treatment of First Metatarsophalangeal Joint Arthritis
17.1 Cheilectomy
17.1.1 Definition and Indications
17.1.2 Percutaneous Surgical Technique
17.1.2.1 Surgical Approaches
17.1.2.2 Creation of Working Space
17.1.2.3 Osteophyte Resection
17.1.3 Postoperative Course
17.1.4 Complications
17.1.5 Results and Conclusion
17.2 First Ray MTP Osteotomy
17.2.1 Definition
17.2.2 Indication
17.2.3 Metatarsal Osteotomies
17.2.3.1 Waterman Procedure
17.2.3.2 Valenti Procedure
17.2.3.3 Weil Procedure (Fig. 17.11)
17.2.4 Phalangeal Osteotomies
17.2.4.1 Moberg Procedure (Initially Described by Bonney)
17.2.4.2 P1 Diaphyseal Shortening
17.2.4.3 Keller Procedure
17.2.5 Combinations
17.2.6 Postoperative Course
17.2.7 Complications
17.2.8 Outcomes
17.3 Conclusion
18: Minimally Invasive Nonconservative Surgery of the First Metatarsophalangeal Joint
18.1 First Metatarsophalangeal Joint Arthrodesis
18.1.1 Minimally Invasive Technique
18.1.1.1 Instrumentation
18.1.1.2 Patient Positioning
18.1.1.3 Surgical Approach
18.1.1.4 Bone Surface Preparation
18.1.1.5 Positioning of MTP1 Arthrodesis
18.1.1.6 Arthrodesis Fixation
18.1.2 Postoperative Course
18.1.3 Indications and Results
18.1.4 Conclusion
18.2 MTP1 Joint Replacement
18.2.1 Definition
18.2.2 Indication
18.2.3 Surgical Technique
18.2.3.1 Surgical Approach
18.2.3.2 Implantation
18.2.4 Postoperative Course
18.2.5 Outcomes
18.2.6 Complications
18.2.7 Conclusion
19: Percutaneous Fusion of the First Metatarsophalangeal Joint
19.1 Surgical Technique
19.1.1 Instrumentation
19.1.2 Patient Positioning
19.1.3 Portals
19.1.4 Preparing the Bone Surfaces
19.1.5 Positioning of MTP1 Arthrodesis
19.1.6 Fixation of the Arthrodesis
19.2 Postoperative Care
19.3 Indications and Results
19.4 Discussion
19.5 Conclusion
References
20: Percutaneous Osteotomy of the Hallux Proximal Phalanx
20.1 Introduction
20.2 Techniques
20.2.1 Standard Surgical Techniques
20.2.1.1 Approach
20.2.1.2 Closing Wedge Osteotomy of P1
20.2.2 Technical Variation
20.3 General Mechanical Advantage
20.4 Osteotomy by Location
20.4.1 Proximal Osteotomy
20.4.2 Diaphyseal Osteotomy
20.4.2.1 Shortening
20.4.2.2 Derotation
20.4.3 Distal Osteotomy
20.5 Complications
20.5.1 Transection of FDL and EDL Tendons
20.5.2 Nonunion
20.5.3 Skin Burns
20.5.4 Rupture of Lateral Cortical Hinge
20.5.5 Secondary Displacement
20.5.6 Screw Protrusion
20.5.7 Overabundant Bone Callus
20.6 Dressings and Postoperative Care
20.7 Results
21: Simultaneous Proximal and Distal Surgery of the First Ray: The Mechanical Principle of “Decoupling”
21.1 Introduction
21.2 Pitfalls and Limitations of TMT1 Fusion
21.2.1 First Ray’s Correction Requisites
21.2.2 Fusion Requisites
21.2.3 Contradictions of the Requisites
21.3 Mechanical Concept of “Decoupling”
21.4 Application Thanks to MIS and PC
21.5 Conclusion
22: Role of the Lapidus Procedure for Treating Hallux Valgus
22.1 General Principles
22.2 Clinical Findings
22.2.1 Direct Signs
22.2.2 Indirect Signs
22.3 General Criteria
22.4 Surgical Technique
22.4.1 Hospitalization
22.4.2 Anesthesia
22.4.3 Patient Positioning
22.4.4 Surgical Procedure
22.4.4.1 Incisions
22.4.4.2 Metatarsophalangeal Arthrolysis
22.4.4.3 Cuneometatarsal Approach
22.4.4.4 Joint Preparation
22.4.4.5 Reduction and Temporary Fixation
22.4.4.6 Fixation
22.4.5 Additional Procedures
22.4.5.1 Distal Osteotomy
22.4.5.2 Akin Osteotomy
22.4.5.3 Lengthening of Extensor Mechanism
22.4.5.4 Second Toe Shortening
22.4.6 Checks, Closure, and Dressings
22.5 Postoperative Course
22.6 Conclusion
Appendix (Dr. Cyrille Cazeau)
Suggested Reading
23: Percutaneous Arthrodesis of the First Tarsometatarsal Joint
23.1 Introduction
23.2 Surgical Technique
23.2.1 Lateral Release
23.2.2 Arthrodesis Groundwork
23.2.3 Bone Cuts
23.2.4 Arthrodesis Fixation (Modified Lapidus)
23.2.5 Additional Fixation (Original Lapidus)
24: Minimally Invasive and Percutaneous Arthrodesis of the Hallux Interphalangeal Joint
24.1 Introduction
24.2 Indications
24.3 Methods and Technique
24.3.1 Minimally Invasive
24.3.2 Percutaneous
24.4 Postoperative Course
24.5 Discussion
24.6 Conclusion
Suggested Reading
25: DMMO
25.1 Introduction
25.2 Anatomical Considerations
25.3 Objectives and Principles
25.4 Conventional DMMO
25.4.1 Instrumentation
25.4.2 Surgical Technique
25.4.2.1 Anesthesia
25.4.2.2 Patient Setup
25.4.2.3 Approach
25.4.2.4 Osteotomy
25.4.2.5 Closure and Postoperative Course
25.5 Oblique DMMO (DOMMO)
25.5.1 Osteotomy Technique
25.6 Reverse DMMO
25.6.1 Osteotomy Technique
25.7 Metatarsophalangeal Dislocation
25.7.1 Introduction
25.7.2 Osteotomy Technique
25.7.3 Conclusion
25.8 Outcomes
25.9 Indications
25.9.1 Mechanical Metatarsalgia in Older Adults
25.9.2 Recurring Metatarsalgia
25.9.3 Propulsive Metatarsalgia
25.9.4 Isolated Metatarsalgia
25.9.5 Combinations
25.10 Specific Complications
25.11 Postoperative Course
25.12 Conclusions
Suggested Reading
26: Percutaneous Basal Elevation Osteotomy of the Metatarsals
26.1 Introduction
26.2 Principles of BRT Osteotomy
26.3 Percutaneous BRT Technique
26.4 Postoperative Course and Complications
26.5 Discussion
26.5.1 Burr or Saw?
26.5.2 Fixation or no Fixation?
26.5.3 BRT Indications
26.6 Conclusion
References
27: Percutaneous Surgery for Bunionette
27.1 Introduction
27.2 Description
27.3 Main Surgical Procedures Used
27.3.1 Standard Technique: Procedures on Fifth Metatarsal
27.3.2 Potential Additional Surgical Procedures
27.3.2.1 Exostectomy
27.3.2.2 Closing Wedge Osteotomy of the Proximal Phalanx Base
27.3.2.3 Medial Soft Tissue Release
27.4 Surgical Technique
27.4.1 Osteotomy at Distal Third of M5
27.4.2 Closing Wedge Osteotomy at the Base of Proximal Phalanx
27.4.3 Exostectomy
27.5 Postoperative Care
28: Percutaneous Treatment of Fifth Ray Deformities (Other Than Bunionette)
28.1 Anatomical Considerations
28.2 General Parameters
28.2.1 Basic Surgical Techniques
28.2.1.1 Soft Tissues
28.2.1.2 Exostectomy
28.2.1.3 Osteotomy
28.2.2 Powered Tools: Burrs and Instruments
28.3 Fifth Toe Supraductus Varus
28.3.1 Percutaneous Treatment
28.3.2 Dressings
28.4 Fifth Toe Infraductus Varus
28.4.1 Percutaneous Treatment
28.4.2 Dressings
28.5 Fifth Hammer and Claw Toe
28.5.1 Percutaneous Treatment
28.5.2 Dressings
28.6 Soft Corn between Toes
28.6.1 Percutaneous Treatment
28.6.2 Dressings
29: Percutaneous Surgery of Lateral Toe Deformities
29.1 Introduction
29.2 Pathophysiology
29.2.1 Extrinsic Muscles
29.2.2 Intrinsic Muscles
29.2.3 Plantar Plate
29.3 Classifications of Toe Deformities
29.4 Combinations
29.5 Clinical Consequences of Lateral Toe Deformities
29.6 Conservative Treatment of Lateral Toe Deformities
29.7 Percutaneous Surgical Treatment of Lateral Toe Deformities
29.7.1 Flexor Tenotomy
29.7.2 Extensor Tenotomy
29.7.3 Osteotomy of First Phalanx (P1)
29.7.4 Osteotomy of Second Phalanx (P2)
29.7.5 Condylectomy
29.7.6 Full Procedure
29.8 Surgical Indications
29.8.1 Morphological Criteria
29.8.2 Reducibility Criteria
29.8.3 Etiology Criteria
29.9 Specific Cases
29.9.1 Without Osteotomy
29.9.2 Without Tenotomy
29.10 Clinical Cases to Illustrate the Indications
References
30: Haglund’s Syndrome: Percutaneous Calcaneal Resection
30.1 Introduction
30.2 Surgical Technique
30.2.1 Instrumentation
30.2.2 Patient Set Up
30.2.3 Surgical Approaches
30.2.3.1 Postero-Superolateral Approach
30.2.3.2 Postero-Supero-Medial Approach
30.2.4 Procedure
30.3 Postoperative Care
30.4 Complications
30.5 Conclusion
31: Plantar Fasciitis
31.1 Introduction
31.2 Etiology
31.3 Clinical Findings
31.4 Diagnosis
31.4.1 History
31.4.2 Clinical Examination
31.4.3 Supplemental Examinations
31.5 Treatment
31.5.1 Conservative Treatment
31.5.2 Surgical Treatment
31.5.3 Authors’ Preferred Method
31.5.3.1 Complete or Partial Fasciotomy?
31.5.3.2 Resection of Calcaneal Spur?
31.5.4 Surgical Technique [12, 13]
31.5.4.1 Instrumentation
31.5.4.2 Patient Setup
31.5.4.3 Anesthesia
31.5.4.4 Locating the Entry Point
31.5.4.5 Fasciotomy
31.5.4.6 Postoperative Course
31.5.4.7 Complications
References
32: Morton’s Neuroma
32.1 Introduction
32.2 Etiology
32.2.1 Anatomy
32.2.2 Etiology
32.3 Clinical Findings
32.4 Diagnosis
32.4.1 History
32.4.2 Physical Examination
32.4.3 Additional Examinations
32.5 Treatment
32.5.1 Conservative Treatment
32.5.2 Surgical Treatment
32.5.3 Percutaneous Nerve Release Technique
32.5.4 Isolated Nerve Release
32.5.5 Nerve Release + DMMO
32.5.6 Closure and Dressing
32.5.7 Postoperative Course
32.6 Outcomes
Appendix 1 (Dr. Cyrille Cazeau)
Appendix 2
References
33: Technique, Indications, and Outcomes of Proximal Medial Gastrocnemius Lengthening
33.1 Introduction
33.1.1 History
33.1.2 Indications
33.2 Surgical Technique
33.2.1 Anesthesia
33.2.2 Patient Setup
33.2.3 Procedure
33.2.4 Postoperative Course
33.3 Complications
33.4 Results
33.4.1 Ankle Dorsiflexion with Knee Extended
33.4.2 Other Effects of Gastrocnemius Contracture
33.4.3 Complications
33.5 Discussion
33.5.1 Outcomes
33.5.2 Bilateral Procedure
33.5.3 Reasons to Lengthen the Medial Gastrocnemius Only
33.5.4 Reasons Why Proximal Lengthening Is Preferred to Distal
33.5.5 Other Thoughts
33.6 Sequencing
33.7 Patient Information
33.8 Conclusion
References
34: Postoperative Dressings and Supports for Minimally Invasive Foot Surgery
34.1 Introduction
34.1.1 Antiseptic Function
34.1.2 Psychological Function
34.1.3 Compliance Function
34.2 Selecting the Dressing Type
34.2.1 Based on Goals
34.2.2 Based on Procedures Performed
34.2.2.1 M1 Osteotomy
34.2.2.2 P1 Osteotomy
34.2.2.3 DMMO
34.2.2.4 Tailor’s Bunion and Fifth Toe Varus
34.2.2.5 Claw Toe Deformity
34.3 Dressing Application
34.3.1 Materials
34.3.2 Principles
34.3.3 Dressing Changes
34.4 Alternatives to Dressings
34.4.1 Toe Spacers
34.4.2 Braces
34.5 Conclusion
Suggested Reading
35: Complications of Percutaneous Forefoot Surgery
35.1 Introduction
35.2 Learning Curve
35.3 Specific Progressions that Are Not Actual Complications
35.4 True Complications
35.5 Conclusion
References