The trend in surgery today is to use increasingly innovative and minimally invasive techniques in order to reduce complications, but more importantly to improve and shorten the postoperative recovery process. Percutaneous foot surgery is a revolutionary surgical technique that fits well into this process. In fact, due to its minimally invasive nature, it is rapidly gaining popularity in foot surgery, increasingly replacing traditional so called “open” techniques.
Invented in the 1990s by Stephen Isham, founder of the Academy of Ambulatory Foot and Ankle surgery, and called M.I.S. (Mini Invasive Surgery), the technique was imported to Europe and developed by Spaniard Mariano De Prado. In recent years this technique has evolved naturally and is now performed in a very different way from what Dr. De Prado taught and described, whose basic principles, however, still remain valid. This method allows the correction of major forefoot disorders such as hallux valgus, hammer toes, metatarsalgia and 5th toe deformities. Some hindfoot pathologies such as calcaneal spur, Haglund’s heel can also be treated, and some surgeons have also begun to perform calcaneal osteotomies. Of course, percutaneous surgery also makes it possible to treat different but associated foot diseases simultaneously. Bone and soft tissue corrections are made with dedicated instrumentation through mini-incisions. This instrumentarium is very small and simple: microblades for skin incisions and any sections of tendons and joint capsules, spatulas with the function of creating a safe working chamber in which to introduce and operate the small surgical instruments, rasps to remove debris and bone material formed by the abrasive function of the burs, motorized burs with an abrasive function on bone prominences and a cutting function to reorient and correct bone deformities. Through the skin incision, it is thus possible to perform precise surgical gestures that can affect both soft and bony parts. Generally, these surgical gestures are performed under control of radioscopic images generated by a brilliance apparatus.

Surgeries are always performed under loco-regional anesthesia, that is, by small doses of local anesthetic to the ankle and foot; the average duration of a procedure is between ten and twenty minutes, and the access routes are so small that patients often mistakenly feel that they have been operated on with a laser. Surgery is usually performed on a day-surgery basis, and the patient is discharged walking as early as a few hours after surgery with a suitable flat, rigid-soled shoe. The foot is wrapped with a functional bandage, which is critical to achieving the result. In fact, the maintenance of the correction, obtained during surgery, will not rely on metal synthesis means, but precisely on the bandage that the patient will have to wear for about a month after surgery. Postoperative pain is usually reduced to a sensation of discomfort and is easily controlled with common analgesics. Another advantage of this technique, in addition to its minimally invasive nature, is the absence of pneumoischemia: in contrast to open surgery, no pneumoischemic tourniquet is used in the thigh or leg to prevent blood flow into the surgical field. By not using the tourniquet, all the complications associated with it can be avoided, and it is also possible to refer patients with peripheral vascular deficits to the procedure, reducing the risks of vascular complications. The combination of the aforementioned advantages makes the percutaneous technique particularly welcome by patients and connotes it, in some cases, as surpassing traditional open techniques, which nonetheless continue to have their application. In fact, percutaneous techniques cannot and should not be used indifferently in all pathologies and all patients, but only when these are harbingers of real benefit. This surgical technique in the right indications greatly reduces postoperative complications, accelerates postoperative recovery, and is an aesthetically unsurpassed surgery because it leaves imperceptible scars. Postoperative pain is very low and the period of immobility is minimized, and for all these reasons it is very agreeable to the patient.