Percutaneous surgery

Orthopedic surgeon specialized in foot care

Percutaneous surgery is a surgical method of performing an intervention. We distinguish traditional surgery by a mini-invasive skin incision whenever possible, percutaneous surgery by small punctiform incisions, and arthroscopic surgery using a camera.

What is percutaneous surgery?

Percutaneous surgery allows the treatment of a surgical condition, when suitable, through small incisions that permit the introduction of a scalpel, a needle, or a powered surgical burr. This minimally invasive technique is part of the modern evolution of orthopedic surgery aimed at reducing tissue trauma and improving postoperative outcomes.

For which conditions is percutaneous surgery performed?

Percutaneous surgery can involve tendons, which can be lengthened or severed using this technique. It is also possible to perform corrective osteotomies.

Tendinous pathologies accessible to percutaneous techniques include:

Pathologies involving bony procedures such as:

The different types of percutaneous surgery

There are different percutaneous surgery techniques for the ankle and foot.

  • Percutaneous procedures can be performed with a "pink" needle, particularly for tenotomies of the flexor tendons of the lateral toes in spastic claw toes and for selective lengthening of the plantar fascia.
  • The scalpel and beaver blade are used percutaneously for Achilles tendon lengthening according to the Judet method, and medial gastrocnemius lengthening according to Strayer.
  • Powered burrs are used to perform corrective osteotomies of the metatarsals, phalanges, and calcaneus.

Percutaneous foot surgery

Percutaneous foot surgery mainly concerns the metatarsals and the phalanges. In cases of metatarsalgia, that is pain in the pads, associated with atrophy of the plantar pad, we perform percutaneous osteotomies of the metatarsals to achieve elevation of the metatarsal heads. Percutaneous osteotomies of the 5th metatarsal are performed to correct deformities of the 5th metatarsal or tailor’s bunion. This technique can also be used in certain cases of neurectomy to treat Morton’s neuroma.

Percutaneous surgery for hallux valgus

We do not perform percutaneous surgery for hallux valgus. Correction of the deformity requires an osteotomy of the first metatarsal, allowing the head to be positioned under the phalanx of the hallux. The aim is to achieve proper positioning of the metatarsal head in all planes of space, that is to say in length, in height, in translation and in rotation, and it seems impossible to us to obtain a precise and stable adjustment of the metatarsal head position with the percutaneous technique. In fact, to increase the precision of positioning the metatarsal head, we developed a dedicated implant for the surgical correction of hallux valgus, the CENTROLOCK. However, the percutaneous technique remains effective for treating hallux rigidus in certain selected cases.

Percutaneous surgery for claw toe

The deformity of claw toes may be amenable to percutaneous surgical treatment. Several procedures can be used either alone or in combination, such as:

How does a percutaneous surgery take place?

A percutaneous surgery is performed in the same way as open or arthroscopic surgery. It requires the same strict aseptic measures and is carried out in the operating room.

The tourniquet is positioned at the ankle or at the root of the thigh, depending on the planned surgical procedures. It is usually not necessary to inflate it because the bleeding is minimal, and it allows the bones being worked on with a burr to cool.

Practice of Percutaneous Surgery at the Nice Foot Clinic

We use percutaneous surgery as a surgical tool when we believe it will improve the quality of post-operative outcomes. Surgical treatment of hallux valgus is never performed percutaneously for reasons of precision in correcting the deformity. In managing hallux valgus, we use a dedicated implant that provides both precise correction adjustment and stability of the construct.

The treatment of claw toes may require tendon transfers which cannot be performed percutaneously. Our team of specialized orthopedic surgeons evaluates each case individually to determine the most appropriate technique.

Advantages and limitations of percutaneous surgery

Percutaneous surgery offers many advantages over traditional techniques. The minimal incisions significantly reduce tissue trauma, resulting in generally simpler postoperative courses with less pain and swelling. Functional recovery is often faster, allowing for an earlier return to walking and daily activities.

However, this technique has its limits. Some complex pathologies require direct visualization of anatomical structures to ensure the precision of the surgical procedure. Percutaneous techniques may also be contraindicated in cases of severe deformities or when stable osteosynthesis is required. This is why the choice of surgical technique must always be individualized according to each patient and their specific pathology.

Complementary techniques to percutaneous surgery

Percutaneous surgery can be combined with other minimally invasive techniques to optimize results. Therapeutic injections can be performed as an additional procedure to treat residual inflammation or improve post-operative comfort. These procedures can be guided by ultrasound for maximum precision.

In some cases, percutaneous surgery can be combined with arthroscopic techniques, particularly for ankle conditions. This hybrid approach allows for the benefits of each technique while minimizing their respective drawbacks. The constant evolution of technologies and surgical instruments continues to expand the indications for percutaneous surgery, offering patients increasingly personalized and less invasive therapeutic options.

Frequently Asked Questions – Percutaneous Surgery

Percutaneous surgery is generally less painful than traditional surgery, thanks to the smaller incisions and preservation of surrounding tissues. However, some post-operative discomfort may persist for a few days, which is well controlled with simple painkillers.

Recovery depends on the type of procedure, but it is often quicker than with open surgery. In general:

  • Walking: within a few days, sometimes with an orthopedic shoe.
  • Returning to work: between 1 and 4 weeks depending on the job.
  • Sports: gradual return between 1 and 3 months.

Although minimally invasive, percutaneous surgery does involve risks, including:

  • Hematomas or temporary bruising.
  • Temporary nerve irritation (tingling, numbness).
  • Infection, although rare due to the minimally invasive approach.
  • Incomplete result requiring further surgery in some cases.

Not necessarily. Depending on the procedures planned, the following may be used:

  • Local or regional anesthesia (spinal anesthesia, nerve block).
  • For multiple or prolonged procedures, general anesthesia may be suggested for the patient’s comfort.

Yes, rehabilitation is often recommended, particularly to:

  • Restore joint range of motion.
  • Re-learn how to walk.
  • Strengthen certain muscle groups.
    It is tailored according to the procedures performed and the patient’s abilities.

Very little. As the incisions are punctiform (often 2-5 mm), the scars are discreet, and even imperceptible in the long term.

Yes, this is common. For example, several claw toes can be corrected or osteotomies and tendon lengthening can be combined during the same operation.

Yes:

  • Keep a dry dressing on for several days.
  • Monitor for signs of infection.
  • Possible wearing of a medical shoe.
  • Avoid getting the dressings wet until they are removed.
    A detailed protocol will be given to the patient after the procedure.

Percutaneous surgery, as a surgical technique, is coded and reimbursed like other surgical procedures when performed in an accredited facility. Additional fees may apply depending on the surgeon’s practice sector.