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