Minimally Invasive Technique for Hallux Valgus Correction

Abstract

The evolution of minimally invasive surgery has led to techniques that can achieve comparable results to that of traditional open methods of surgery. For hallux valgus correction of the foot, several studies have demonstrated the equivalency between open procedures and current minimally invasive procedures in terms of stability and final outcomes. The authors present a detailed technique for minimally invasive hallux valgus correction. Early clinical and radiographic outcomes are reported, including a comparison of chevron and transverse osteotomies.Level of Evidence: Diagnostic level IV, case series. See Instructions for Authors for a complete description of levels of evidence.

Fourth Generation Hallux Valgus Correction

“…30 Nevertheless, despite large translations, little bony apposition, and early weight bearing, bunion correction techniques consistently display reliable bone healing. 1,3,9,17 We postulate that this seeming contradiction may be explained by a number of factors including minimal soft tissue stripping with maintenance of lateral periosteum and blood supply. In addition, the rigid internal fixation afforded by the recommended screw construct (at least one screw with purchase in both cortices proximal to the osteotomy) results in primary bone healing, evidenced by little to no callus formation as well as new bone formation in the lateral "clear space" proximal to the metatarsal head after correction (Fig.…”

“…Notably, the transverse osteotomy also resulted in faster radiographic healing. 9 In addition, Lewis et al 3 analyzed 50 patients undergoing MIS correction of hallux valgus deformity with transverse and akin osteotomy with a minimum 12 month follow-up. They reported significant improvements in patient-reported outcomes, radiographic results, and quality of life measures.…”

“…The third generation of MIS correction implemented advances in surgical tools to minimize trauma during the procedure, and incorporating a method of rigid internal fixation utilizing cannulated screws to increase the reliability of the procedure 9,10 . This third-generation technique utilized a low-speed/high torque cutting burr to perform chevron and akin osteotomies and compression screws for rigid internal fixation.…”

“…This method of rigid internal fixation resulted in more predictable results and allowed for early weight bearing. In the time since, minimally invasive hallux valgus correction has become a widely used procedure demonstrating positive outcomes 9–11 …”

“…become a widely used procedure demonstrating positive outcomes. [9][10][11] This paper describes a fourth-generation minimally invasive bunion correction utilizing a transverse osteotomy of the distal metatarsal and Akin osteotomy with rigid internal fixation. Purported benefits of this technique include the ability to correct mild, moderate and severe hallux valgus deformities in coronal, sagittal, and axial planes with enhanced stability that allows for early weight bearing and rehabilitation.…”