02/10/2025    Joseph Borreggine, DPM

MIS Now Out of the Shadows

I recently attended the SAM meeting in Orlando.
During the meeting, there was a track of lectures
that was dedicated to MIS or minimal incision
surgery. I found it quite interesting that MIS has
come out of the shadows as a “new thing” in
podiatry. There were numerous lectures on a number
of MIS procedures from bunion and hammertoe
correction to correcting Charcot foot (including
using external frames).There were a number of
speakers who were well-respected peers in the foot
and ankle surgical field who spoke on their
expertise regarding the advantages of using MIS
versus traditional open procedures.

This is not a new debate in podiatry and has been
around since the 1960s but never gained traction
in the profession because the MIS foot surgeons
were considered the “charlatans” of our time who
were untrained and just trying to make a quick
buck using the same CPT codes only relegated to
the traditional procedures used only by “real”
foot surgeons.

The traditional surgeon demographic, podiatric
surgical boards, other professional associations
opined that this was not fair. That a well trained
podiatric surgeon could never be compared to a
poorly trained “matter of fact” “fake” foot
surgeon. Let alone make the same amount of money.
So, as podiatry does and will always do. It
cannibalized itself for the good of the
profession.

MIS surgeons were continually chastised and
bastardized by our residency trained colleagues on
staff at hospitals as “lesser than” and “no good”
to the profession. The Ambulatory Board of
Podiatric Surgery which was the surgical board for
MIS was dismantled and dissolved because of non-
acceptance by the profession.

Yes, it is true that the infamous podiatrist,
Seymour Kessler, DPM in Chicago back in the 1970’s
and 80’s was singled out as the top “crack pot” in
podiatry who was a “minimal incision zipper” who
had numerous lawsuits against him.

This fueled by podiatric “experts” who worked for
lawyers testifying against MIS podiatrists and by
an investigative report from a Chicago TV news
station on “bad outcomes” that patients claimed
were a result of his MIS procedures. This did
nothing, but add fuel to the fire to destroy the
reputation of any podiatrist performing MIS (or
affiliated with Dr. Kessler) at the time and rid
this type of surgery from podiatry forever.

So, as time passed memories must have faded and
MIS began its slow resurgence back into the
profession. I find it interesting that this
profession has short term memory of what it did to
our MIS colleagues and now how we have embraced
the MIS techniques as innovative standard of care
and technologically advanced form of surgical
treatment in the podiatric profession.

But, as things go, things circle back around but
not always in the same version as it once was, but
rather “new and improved”. There were many a DPM
back in the day that were considered just like
Copernicus or Lister who were criticized and
shunned, but some how their theories of the truth
became an accepted reality as time progressed.
They are now considered heroes rather than the
“insane people” everyone thought they were. The
same holds true for the pioneers of MIS.

What is different? Well, let’s look at that. The
American Board of Foot and Ankle Surgery accepts
these MIS surgical procedures as submitted cases
as prerequisite along with traditional foot and
ankle surgical cases for getting certification,
MIS cases are performed in the hospital with all
the equipment that once hidden away in podiatry
offices, podiatry residencies are teaching these
techniques as “new” procedures in the podiatric
surgical arena, there is literature supporting
outcomes, and finally let’s follow the money. Yes,
“the money”. Surgical supply vendors saw an
opportunity and grabbed it by the horns. They
created surgical instruments, hardware, and
techniques to performed said MIS surgery all in
the name of money.

So, let’s go back to the 70’s a moment and fast
forward 50 years later to advertising the
advantages of MIS, “Small incision, no casts, no
pins, and walk right away!!”. Words that made us
cringe back then are now the accepted verbiage of
the foot and ankle surgeons today. A lesson
learned for sure. Never forget the past because it
creates the present and ultimately the future
good, bad or indifferent.

Joseph Borreggine, DPM, Fort Myers, FL

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02/11/2025    Mark Hinkes, DPM

MIS Now Out of the Shadows (Joseph Borreggine, DPM)

As a traditionally trained podiatrist who was
taught "open" foot surgery procedures in my
residency, I remember hearing about MIS foot
surgery procedures and wondering if adding those
procedures to my armamentarium would be of value
to my patients. To learn more about MIS foot
surgery techniques, I traveled to New York with a
colleague to attend a course taught by Edwin
Probber, DPM.

About 6 podiatrists sat in a room in the back of
his office we affectionately called “the bunker"
and watched Dr. Prober via closed circuit TV
perform MIS procedures. What I saw was both
frightening and amazing at the same time. There
was a lot of head shaking going on. I asked
myself, how could he do this without destroying
vital structures in the foot that could not be
seen while doing these procedures? I remember
being taught not to place a blade in a place that
I could not directly see it. MIS foot surgery
challenged all of what I had been taught and
learned about traditional "open" surgical
procedures. I did not have the opportunity to see
any long-term results from these procedures, so I
felt I was only exposed to half of the world of
MIS foot surgery. I had heard of the botched cases
and was concerned about this, always wanting the
best post-op results for my patients. There were
some aspects of how Dr. Probber interacted with
his patients that I disagreed with
philosophically, nevertheless it was the technique
I wanted to learn more about.

After witnessing all that happened in my visit to
Dr. Probber's office, I left with more questions
than answers. Knowing that MIS type procedures
have been employed by other surgeons on other
parts of the human body gave me enough confidence
to read and learn more about them. After
acquiring what I felt was enough knowledge, I
started to employ MIS procedures in selected cases
that I felt competent in performing. My results
were excellent and I was happy that I took the
time to learn about them.

The lesson I learned was to be open-minded about
new techniques and to have the ability to
personally challenge myself to be a better
podiatrist.

Mark Hinkes, DPM, Nashville, TN