Minimally Invasive Foot Surgery: Percutaneous Techniques and Who Is a Candidate

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

▶ Watch

Minimally invasive foot surgery (MIS) — also termed percutaneous foot surgery — has undergone a significant renaissance over the past decade, driven by improved instrumentation, surgeon training programs, and a growing evidence base demonstrating outcomes comparable to traditional open techniques with meaningful advantages in incision size, soft tissue disruption, and recovery. For properly selected patients, MIS bunion and hammertoe correction represents a paradigm shift in foot surgical care — transitioning procedures that previously required weeks of non-weight-bearing to surgeries that allow immediate protected weight-bearing in a surgical sandal.

Principles of Minimally Invasive Bone Surgery

MIS foot surgery uses 2–3mm stab incisions through which burrs, chisels, and rasps are introduced under continuous fluoroscopic (X-ray) guidance to perform osteotomies (bone cuts), resections, and corrections without open dissection or large incisions. The key instrumentation is a motorized Shannon burr, which oscillates (rather than rotates) to cut bone with precision while minimizing heat generation and soft tissue injury. Fluoroscopic guidance is mandatory — the surgeon operates by feel and real-time X-ray imaging rather than direct visualization, requiring dedicated training for competency. The advantages of MIS are substantial in appropriate cases: minimal scarring, reduced post-operative swelling, lower infection risk (the primary portal of bacterial entry is the incision), faster return to regular footwear, and the ability to address multiple procedures through several small incisions simultaneously.

MIS Bunion Correction: MICA and MIBO Techniques

The Minimally Invasive Chevron Akin (MICA) procedure has become the most widely studied MIS bunion technique. Through two 2–3mm incisions, a distal metatarsal chevron osteotomy is performed with fluoroscopic guidance, the metatarsal head is translated laterally to correct the intermetatarsal angle, and fixation is achieved with 1–2 headless compression screws placed percutaneously. A concurrent Akin osteotomy (proximal phalangeal closing wedge) corrects residual hallux valgus interphalangeus. Multiple prospective studies, including comparative trials against open chevron osteotomy, demonstrate MICA produces equivalent radiographic correction and patient-reported outcomes with lower wound complication rates, less post-operative swelling, and earlier return to regular shoes. Immediate partial weight-bearing in a surgical sandal is the standard post-operative protocol for most MIS bunion procedures. MIS bunion correction is not equivalent to all open procedures — patients with severe bunion deformity, hypermobile first tarsometatarsal joint (requiring Lapidus/Lapiplasty fusion), or prior failed bunion surgery are generally better served by established open techniques.

MIS Hammertoe Correction and Plantar Fascia Release

Percutaneous flexor tenotomy for flexible hammertoes and claw toes is perhaps the simplest MIS foot procedure — a 2mm stab incision and blind tenotomy blade release of the flexor tendon under the toe, performed in the office under local anesthetic with immediate return to activity. More complex MIS hammertoe correction through percutaneous diaphyseal osteotomy (DMMO — distal metatarsal metaphyseal osteotomy) addresses metatarsalgia by shortening the relevant metatarsal through a single 3mm dorsal incision. Endoscopic plantar fasciotomy (EPF) and percutaneous plantar fascia release are also well-established MIS techniques for refractory plantar fasciitis, releasing the medial band of the plantar fascia through minimal incisions with direct or fluoroscopic visualization. Dr. Biernacki at Balance Foot & Ankle offers minimally invasive foot surgery for appropriate candidates alongside the full range of open reconstructive procedures, selecting the optimal technique for each patient’s specific deformity and goals. Call (810) 206-1402 for a surgical consultation.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

More Podiatrist-Recommended Surgery Essentials

OOFOS Recovery Slide

View on Amazon →

Post-op approved — impact-absorbing slide for early recovery.

HOKA Ora 3 Recovery Slide

Max-cushion recovery sandal — comfort for post-surgical swelling.

Hoka Bondi 9

Max-cushion walking shoe — ease into return-to-walking post-surgery.

As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.

When to See a Podiatrist

Foot and ankle surgery in 2026 is dramatically different than a decade ago — most procedures are now minimally-invasive, outpatient, and allow weight-bearing within days. Balance Foot & Ankle surgeons have performed 3,000+ foot/ankle surgeries with modern techniques. If another surgeon has recommended a traditional open procedure, a second opinion may reveal a faster, less-invasive option.

Call Balance Foot & Ankle: (810) 206-1402  ·  Book online  ·  Offices in Howell & Bloomfield Hills

Dr. Tom’s Recommended Products for foot care

Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.

Hoka Bondi 9 Dr. Tom’s Pick

Best for: Max cushion daily wear

Check Price on Amazon

PowerStep Pinnacle Dr. Tom’s Pick

Best for: General arch support

Check Price on Amazon

KT Tape Pro Synthetic Dr. Tom’s Pick

Best for: Multi-purpose taping

Check Price on Amazon

Footnanny Heel Cream Dr. Tom’s Pick

Best for: Daily moisturizer for cracked heels

Check Price on Amazon

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.