Jennifer Spector, DPM, of Podiatry Today, and Bradley P. Abicht, DPM, examine the trends shaping minimally invasive surgery.
Why Minimally Invasive Surgery Continues to Grow
Dr. Spector: What have you noticed about the overall philosophy of foot and ankle surgery over the past several years?
Dr. Abicht: Innovation is reshaping practice, with new technologies focused not only on improving patient care but on making procedures more reproducible.
Minimally invasive surgery (MIS) often comes with a steep learning curve. As instrumentation becomes easier to use and more consistent, surgeons can adopt these techniques with greater confidence.
The more we can reduce the learning curve by developing instrumentation that's easier to use and more reproducible, the better the outcomes we can achieve.
At the same time, a growing body of clinical evidence is refining surgical techniques and treatment decisions, further advancing the field.
As the evidence grows, surgeons are exploring how procedures traditionally performed through an open approach can be adapted to MIS.
Dr. Spector: What trends have you noticed specifically with MIS over the last two or three years?
Dr. Abicht: MIS has expanded well beyond bunion procedures, which were among the earliest and most common applications of the technique. Surgeons now apply MIS principles to hindfoot procedures, ankle osteotomies, arthrodesis, and many other surgeries.
Patients continue benefiting from minimally invasive approaches through faster recovery, fewer wound complications, lower infection risk, and generally less postoperative pain compared to traditional surgery.
As the evidence grows, surgeons are exploring how procedures traditionally performed through an open approach can be adapted to MIS.
Patient Selection Still Comes First
Dr. Spector: Are patient expectations helping drive the growth of MIS?
Dr. Abicht: Absolutely. Patient demand has become an important factor. Many patients come into the office familiar with MIS and are looking for smaller incisions, faster recovery, and an easier overall experience.
One of the most rewarding things is treating patients who previously underwent an open procedure and later have a minimally invasive procedure on the opposite foot, so they can compare both recoveries.
That's what it's all about—making the perioperative experience easier for patients while still achieving excellent outcomes.
Dr. Spector: How important is patient education, especially in helping patients understand when MIS isn't appropriate?
Dr. Abicht: It’s essential. MIS offers many benefits, but it isn't the right option for every patient. I continue to perform many open procedures because in some cases it’s the better approach.
Setting realistic expectations is always important. At the end of the day, it's still surgery. Whether the procedure is open or minimally invasive, patients need to understand the risks, potential complications, and recovery process before moving forward.
Making MIS More Reproducible
Dr. Spector: How can surgeons overcome the learning curve of MIS?
Dr. Abicht: The first step is hands-on training in cadaver labs, educational courses, and industry-sponsored courses. Understanding the procedure, recognizing common pitfalls, and building practical experience are all critical.
I also believe surgeons should have a solid foundation in performing these procedures with an open approach before transitioning to minimally invasive techniques.
As we continue to innovate, we find ways to make these procedures easier to perform while reducing the learning curve.
Dr. Abicht: What's the most satisfying aspect of foot and ankle surgery?
Dr. Spector: The most rewarding part has always been to keep learning, whether I was practicing or working in education. There's always new evidence, techniques, and perspectives.
Ultimately, that growth is in service of better patient outcomes.
Dr. Abicht: I completely agree. One of the most rewarding aspects of MIS is the collaboration in the community. Podiatric colleagues, orthopedic surgeons, international faculty—everyone learns from each other.
That constant exchange of ideas keeps practice exciting. I'm looking forward to seeing where the specialty goes over the next decade.
Dr. Abicht: How do you decide if a patient is a candidate for MIS or open surgery?
Dr. Spector: Every treatment decision starts with the individual. You have to consider the patient's goals, recovery expectations, and risk factors before weighing the advantages and disadvantages of each approach.
Dr. Abicht: If we can achieve the same surgical goals through smaller incisions while making the perioperative experience safer and easier for the patient, that's a meaningful advantage.
If my patient is happy with the outcome, that's the ultimate measure of success.
Dr. Abicht: How have your preferences for fixation constructs changed over the course of your career?
Dr. Spector: They’ve definitely evolved. Training with a large group of surgeons exposed me to a variety of fixation techniques and philosophies, including the early generations of absorbable fixation. Even still, I ultimately came to prefer the stability and predictability of traditional metal fixation.
It’s exciting to have so many implant choices, because it allows surgeons to tailor not only the procedure but the fixation strategy to each patient.
Dr. Abicht: MIS often relies on screws because procedures are performed through very small percutaneous incisions, although some surgeons can place plates through similarly small approaches.
At the same time, fixation technology has continued to evolve, with innovations including variable-angle screws, fully threaded compression screws, chamfered screw heads, radiolucent plating systems, PEEK implants, and advances in plates and staples.
The key is selecting the right construct based on the patient's anatomy, pathology, and surgical goals.
Wires First: A “Meaningful” Innovation
Dr. Spector: What is your favorite Enovis technology?
Dr. Abicht: I'm probably biased, but I'd say the Pecaplasty® Wires First™ jig.
Accurate guide wire placement has always been one of the biggest challenges in minimally invasive bunion surgery. The jig helps surgeons consistently place those wires in the correct position, significantly reducing the learning curve and simplifying one of the most technically demanding steps.
We've put it in the hands of students, residents, and fellows, and many of them can perform that step successfully on their very first attempt.
Surgeons still need to understand the principles behind MIS bunion surgery, but the Pecaplasty® Wires First™ jig makes these techniques more reproducible and approachable. For me, that's been one of the most meaningful innovations.
*Dr. Abicht is a paid consultant of Enovis.