AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-MIS Applications in Bunion Surgery-Peter Mangone, M.D.

MIS Applications in Bunion Surgery-Peter Mangone, M.D.

Pdf Summary

This document details the Minimally Invasive Chevron Akin (MICA) bunionectomy procedure as presented by Dr. Peter G. Mangone. The MICA technique is a minimally invasive surgery (MIS) aimed at correcting hallux valgus deformities and bunions with goals similar to open surgery: pain relief, deformity correction, and functional improvement. MIS offers benefits such as smaller incisions, reduced pain, fewer wound complications, better cosmetic outcomes, and suitability for patients with poor skin or vascularity. However, MIS requires careful patient selection and surgical skill due to a significant learning curve.<br /><br />MICA involves an extra-capsular Chevron osteotomy with minimal capsular tightening, enabling earlier weightbearing though swelling may persist longer. The procedure uses specialized low-speed, high-torque power tools with irrigation for osteotomy cuts. Initial K-wires are placed under fluoroscopic guidance, followed by precise osteotomies and lateral translation of the first metatarsal head. Fixation uses two screws engaging both cortices to ensure stability, with careful attention to rotational alignment and sesamoid reduction, just as in open surgery. An Akin osteotomy of the proximal phalanx is performed similarly with small burrs and screw fixation.<br /><br />Postoperatively, patients begin protected weightbearing immediately, with strapping dressings to maintain correction. Elevation and orthopaedic shoes are used for six weeks, with gradual return to full activities by six weeks. Case examples demonstrate minimal pain, satisfactory correction, early return to function, and good cosmetic results.<br /><br />Additionally, the document describes MIS applications in acute Charcot foot deformity in diabetic neuropathic patients, showing successful midfoot realignment, minimal incisions, and solid fixation with good long-term outcomes. The presenter emphasizes careful technique, frequent imaging, and surgeon persistence to master MIS bunion surgery and its benefits.

Keywords

Minimally Invasive Chevron Akin

MICA bunionectomy

hallux valgus correction

minimally invasive surgery

osteotomy techniques

first metatarsal fixation

postoperative care

Charcot foot deformity

diabetic neuropathy

surgical learning curve