June 2019

Foot and Ankle Surgery: A “Minimal” Future

By Patrick A. DeHeer, DPM

Before pronouncing what I predict will be the single most significant change in foot and ankle surgery in coming years, it’s essential to look back. I asked an orthopedic colleague what he thought the most significant change in orthopedics was over the past 25 years, and he replied, “locking plate technology.” I agree.

My Prediction? Minimal-incision Surgery

Back in the 1980s and 1990s, minimal-incision surgery (MIS) garnered a bad reputation—rightfully so, in my opinion. Today, however, an orthopedic approach to foot and ankle surgery is making a comeback—this time with better equipment and a significantly improved technical approach to specific procedures. This is where I lean: I began incorporating MIS into my practice about 3 years ago, using SERI*/Bosch bunion surgery. I have probably performed approximately 150 such surgeries, learning a great deal along the way about this specific procedure.

I have slowly expanded my utilization of MIS to other foot and ankle procedures; a variety of lower-extremity procedures now have MIS alternatives. When appropriate, MIS offers significant, apparent advantages. And as with any new procedure, critical evaluation of your outcomes and technique is essential to obtaining consistently optimal results.

The Missing Component of MIS

Looking ahead, the vital element for the advancement of MIS is evidence-based research. MIS foot and ankle surgeons are, historically, more clinically oriented than research-based, but anecdotal evidence is no longer adequate; the lack of substantive MIS research must change. Scientific examination—of analytical modifications of MIS indications, techniques, equipment, and postoperative care—must become the rule, not the exception.1 It is incumbent on those leading this approach in the foot and ankle field to accept the responsibility to advance and standardize the MIS approach to lower-extremity procedures.

Advancement in foot and ankle surgery over my 28-year career has been astonishing; evolution will continue over the next decade. What will the most significant improvement be? I am excited to see where innovation, forward-thinking, evidence-   based medicine, and outside-the-box thinking takes us. It should be a fantastic ride.

Let me conclude by congratulating Lower Extremity Review on its 10th anniversary. Bravo!

Patrick A. DeHeer, DPM, practices foot and ankle orthopedic surgery at Hoosier Foot & Ankle, Franklin, Indiana, and is Podiatric Residency Director at St. Vincent Hospital, Indianapolis, Indiana and President and Founder of the FootAid Network (www.footaid.org).


Kaufmann G, Dammerer D, Heyenbrock F, Braito M, Moertlbauer L, Liebensteiner M. Minimally invasive versus open chevron osteotomy for hallux valgus correction: a randomized controlled trial. Int Orthop. 2019;43:343-350.


* Simple, Effective, Rapid, and Inexpensive. 

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