Joel Vernois

Percutaneous Surgery of the Forefoot

This article describes some of the common techniques used in percutaneous surgery of the forefoot. Techniques such as minimally invasive chevron Akin osteotomy for correction of hallux valgus, first metatarsophalangeal joint cheilectomy, distal minimally invasive metatarsal osteotomies, bunionette correction, and hammertoe correction are described. This article is an introduction to this rapidly developing area of foot and ankle surgery. Less invasive techniques are continually being developed across the whole spectrum of surgical specialties. The surgical ethos of minimizing soft-tissue disruption in the process of achieving surgical objectives remains at the center of this evolution.

Percutaneous Surgery for Metatarsalgia and the Lesser Toes

The traditional open surgical options for the treatment of metatarsalgia and lesser toe deformities are limited and often result in unintentional stiffness. The use of percutaneous techniques for the treatment of metatarsalgia and lesser toe deformities allows a more versatile and tailor-made approach to the individual deformities. As with all percutaneous techniques, it is vital the surgeon engage in cadaveric training from surgeons experienced in these techniques before introducing them into his/her clinical practice.

Minimally Invasive Surgery Osteotomy of the Hindfoot

A minimally invasive surgical approach has been developed for hindfoot as well as forefoot procedures. Percutaneous techniques have been evolving for more than 20 years. Many conventional surgical techniques can be performed percutaneously after training. Percutaneous surgical techniques require knowledge specific to each procedure (eg, percutaneous Zadek osteotomy or percutaneous medial heel shift). In the treatment and correction of the hindfoot pathology the surgeon now has percutaneous options including medial or lateral heel shift, Zadek osteotomy, and exostectomy with/without arthroscopy.

Percutaneous Surgery for Severe Hallux Valgus

Severe hallux valgus is a challenge to treat. If the basal osteotomy is a well known surgery for severe deformity, the chevron osteotomy is usually used in mild to moderate deformity. With a accurent fixation the chevron can also be used in severe deformity. Both techniques can be performed percutaneously and offer reliable techniques.

Minimally Invasive Chevron Akin (MICA) for Correction of Hallux Valgus

This article describes the percutaneous technique of minimally invasive chevron and akin for correction of hallux. The minimally invasive chevron and akin is the first percutaneous technique for correction of hallux valgus to combine percutaneous osteotomies with the benefits of modern rigid internal fixation. Level of Evidence: Diagnostic Level 3. See Instructions for Authors for a complete description of levels of evidence.

Arthroscopic FHL Harvest and Transfer for Neglected TA Rupture

Introduction: Flexor hallucis longus (FHL) transfer is an established method for repairing neglected tendo Achilles ruptures when the tendon gap is in excess of 6 cm. Some patients will have significant comorbidities—for instance, diabetes mellitus—or may be using corticosteroids, making conventional surgery more risky in terms of wound healing and soft tissue repair. In an attempt to circumvent these potential problems the authors have devised a technique to harvest FHL minimally invasively. The purpose of this paper is to describe the early results in 8 patients with 9 Achilles ruptures. Materials and Methods: Patients with a delayed tendo Achilles rupture with a gap measured by ultrasound or magnetic resonance imaging to be over 6 cm suitable for a short FHL harvest were included in this study. The posterior ankle arthroscopic approach popularized by Van Dijk was adopted to gain access to the joint and visualize the FHL tendon. A short tendon harvest was performed through a mini-incision and the FHL routed into a tunnel drilled into the os calcis. The tendon was then secured with an interference screw. The postoperative regimen included 6 weeks of protected weight-bearing in a boot, followed by physiotherapy. The outcome measures included pain, gait assessment, and the ability to perform a single heel raise at 3 months. Results: A total of 8 patients, 3 women and 5 men, aged 65 to 77 years, were included in this study. Comorbidities included high BMI in 2 (35 to 39), use of steroids in 1, and postthrombotic limb in 1. There were no wound-healing issues. Patients were pain free with normal gait. One patient was able to perform single leg raises. Conclusions: This combined technique may offer a safer surgical pathway for low-demand patients with a potential for wound problems if treated with open surgery. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.