Use of cannulated bone screws, as compared with use of traditional bone screws, has been reported to decrease surgical time, allow for more precise screw placement, and reduce sources of error. Cannulation of the smaller-size screws that are routinely used in foot surgery has not been available until the last few years. This article reports on the use of the small cannulated screws manufactured by Alphatec Manufacturing, Inc (Palm Desert, California). The screw sizes available in the Mini Lag Screw System are 2.7, 3.5, and 4.0 mm. A long-term clinical and radiographic prospective evaluation of 70 procedures performed on 49 patients was conducted. The follow-up time for all patients was 2 years. None of the 70 implants fractured, and seven procedures (in seven patients) resulted in some type of implant-fixation failure. All of the fixation failures, however, appeared to be related to an untoward event or patient noncompliance. These smaller cannulated screws proved to be a reliable and effective means of fixation in foot surgery.