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Minimally invasive foot and ankle surgery is performed through “key hole” incisions. Using special instruments and cameras along with intra-operative x-rays, your doctor can access the damaged areas and protect the surrounding muscles, tendons and ligaments.
Advanced Foot and Ankle Expertise at BIDMC
Foot and Ankle surgeon Christopher Miller, MD, has developed new minimally invasive procedures for Achilles tendon rupture repair and reconstruction and is continuing to pioneer minimally invasive techniques for complex foot and ankle surgeries. He has lectured and taught other surgeons these techniques nationally.
Benefits of Minimally Invasive Surgery
Minimally Invasive Surgery (MIS) is a technique that uses smaller and fewer incisions during surgery to minimizing damage to muscle, tendons, ligaments and surrounding structures. This approach leads to less pain and scarring and often, faster recovery from surgery. Minimally invasive surgery returns you to your life and activities quicker and decreases the need for pain medication.
Other benefits of minimally invasive foot and ankle surgery include:
Less swelling
Decreased wound infections
Less blood loss
Less post-operative pain
Conditions We Treat
Some of the procedures which can be effectively treated through minimally invasive surgery at BIDMC include, but are not limited to:
Achilles tendinitis
Achilles tendon ruptures
Ankle arthritis
Ankle fracture
Ankle instability
Ankle osteochondral lesions
Bone spurs
Bunions
Calcaneal (heel) fractures
Flat feet
Great toe arthritis
Haglunds and heel spurs
Hammer toes
Metatarsalgia
Midfoot arthritis
Peroneal tendinitis
Plantar fasciitis
Posterior tibial tendinitis
Dr. Chris Miller explains how minimally invasive foot and ankle surgery techniques available at BIDMC can potentially lead to less pain and scarring and faster recovery
A bunion deformity is a painful bump at the base of the great toe. These may worsen over time and force you to limit your physical activity and shoe wear.
When non-surgical treatments no longer work, your surgeon may recommend repair of the bunion with a minimally invasive technique. The benefit of this technique is that you can often walk on your heel and side of your foot as early as the day after surgery. Generally, you can return to wearing regular shoes within a month. Finally, because of the small incision size, there is usually less pain than with traditional bunion surgery.
Arthritis of the great toe is common and can occur after injury, trauma or with imbalance of the ligaments. It often affects younger people than other types of arthritis and can be very debilitating.
There are several options for treating hallux rigidus, but the most common surgical treatments include:
a cheilectomy to remove bone spurs from the top of the joint
a fusion of the painful joint
Both of these treatments can be performed with an MIS approach. For cheilectomy, the surgeon will use a special instrument to remove the spur through a 3mm incision near the painful bone spur. Due to the small size of the incision, you may experience minimal pain following the surgery and will be allowed to walk immediately since there is so little risk of wound complications.
If you have pain in your Achilles tendon where it attaches to your heel bone you may have learned that this issue will not improve with physical therapy or conservative treatment alone. Traditional surgery involves a large incision directly on the back of the heel in order to remove the bone and reattach the tendon. This is a high-risk area of the body for healing and complications after surgery may occur, such as infection and wound healing issues.
With an MIS approach, the incisions are much smaller and have less risk of infection. Your surgeon can remove the bone with a bur and then perform an arthroscopy of the posterior ankle to evaluate and repair the tendon back to the bone. Without major surgical wounds, many patients who would otherwise be ineligible for this procedure due to high risk of wound healing issues may be candidates for this MIS procedure.
The day after surgery, you will be are allowed to fully weight-bear as tolerated in a boot.
Flat foot can cause pain at the inside of your ankle. Many times, this is due to posterior tibial tendinitis, which allows you to invert your foot and stand up on your tip toes with one foot. When this tendon becomes inflamed and degenerative, your foot can start to deform.
The most common treatment for this condition involves performing a lengthening of the calf muscle, an osteotomy (cutting and shifting) of the heel bone and reconstructing the tendons and ligaments to improve the shape of the foot. Many parts of this surgery can now be performed with MIS procedures, including calf lengthening, using two key hole incisions and an endoscopic camera to lengthen the tendon. In addition, the calcaneal osteotomy can be done through a 5mm incision rather than a 2-inch incision on the outside of your foot. With an MIS approach, pain, scarring and the risk of accidental injury to nerves and veins are lower than with traditional surgery.
Hammer toes are toe deformities that often affect seniors or occur in association with bunions. Sometimes, they may be caused by changes to the foot due to tightened tissue, or after trauma to the foot. With MIS techniques, recovery time after surgery is often faster and less painful.
One of the most exciting uses of MIS foot and ankle surgery is to combine ankle arthroscopy with ligament repair and reconstruction.
Ankle sprains are common and generally resolve in 1-2 months. Unfortunately, some people experience long-term difficulties that do not heal on their own due to injuries to ankle cartilage or ligaments. When physical therapy and bracing are not enough, your surgeon may recommend a procedure to evaluate and treat the damaged cartilage and repair the ligaments. This procedure has traditionally combined arthroscopic and open surgery techniques.
With a MIS approach, the entire ligament repair can be safely and effectively performed with an all-arthroscopic technique through a 5mm incision, as opposed to a 3-4 inch incision.
