Evolution of minimally invasive surgery (MIS) techniques in forefoot deformity corrections

To review the historical evolution and technical progression of minimally invasive surgery (MIS) in forefoot deformity corrections, tracing its development from early medical concepts and general surgery milestones to modern, highly specialized foot and ankle interventions.

An extensive electronic search of the medical and historical literature was performed and complemented by manual review of scientific sources. Historical reports describing the origins of minimally invasive techniques, the evolution of surgical instrumentation, and advancing treatment strategies for forefoot deformities were critically analysed within their scientific and chronological contexts.

The history of forefoot MIS represents a continuous process of conceptual evolution. The procedure's trajectory mirrors the disruptive history of laparoscopic surgery, transitioning from early enthusiasm and high complication rates in the United States to a European-led renaissance grounded in strict anatomical landmarks and technological advancements, such as the Shannon burr and image intensifiers. For hallux valgus, the procedure has progressed through four distinct generations distinguished by specific osteotomy and fixation strategies, moving toward true three-dimensional deformity correction. In the treatment of hallux rigidus, MIS provides effective joint-preserving options through percutaneous cheilectomies and decompressive osteotomies, as well as joint-sacrificing arthrodesis. For lesser toe deformities, treatment paradigms have shifted toward more standardised classification, and utilizing hardware-free metatarsal and phalangeal osteotomies that rely on strict postoperative weight-bearing to achieve optimal anatomical alignment.

The historical maturation of forefoot MIS illustrates a continuous refinement of surgical "processes" and hardware "ingredients" aimed at optimizing clinical outcomes. Understanding this evolutionary framework provides a crucial foundation for future innovations, including the integration of bioabsorbable implants, 3D-printed instrumentation, and artificial intelligence in foot and ankle surgery.