Minimally invasive surgery for hallux valgus

NewsBot · Mar 2, 2024

Improving the Accuracy of Metatarsal Osteotomies in Minimally Invasive Foot Surgery Using a Digital Inclinometer: Preliminary Study
Carlos Fernández-Vizcaino et al
Sensors (Basel). 2024 Feb 5;24(3):1022

Minimally invasive foot surgery (MIS) has become a common procedure to treat various pathologies, and accuracy in the angle of metatarsal osteotomies is crucial to ensure optimal results. This randomized controlled trial with 37 patients investigates whether the implementation of a digital inclinometer can improve the accuracy of osteotomies compared to traditional freehand techniques. Patients were randomly allocated to group A (n = 15) receiving inclinometer-assisted surgery or group B (n = 22) receiving conventional surgery. Osteotomies were performed and outcomes were evaluated using an inclinometer. The inclinometer group showed a significant decrease in plantar pressure from 684.1 g/cm2 pretreatment to 449.5 g/cm2 post-treatment (p < 0.001, Cohen's d = 5.477). The control group decreased from 584.5 g/cm2 to 521.5 g/cm2 (p = 0.001, Cohen's d = 0.801). The effect size between groups was large (Cohen's d = -2.572, p < 0.001). The findings indicate a significant improvement in accuracy and reduction in outliers when using an inclinometer, suggesting that this technology has the potential to improve surgical practice and patient outcomes in minimally invasive metatarsal osteotomies.
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NewsBot · May 22, 2024

Minimally invasive intelligent innovative technologies in foot and ankle surgery: development status and prospects
J C Gui, R Yin
Zhonghua Wai Ke Za Zhi. 2024 Apr 29;62(6):514-519

The rapid development of technology has ushered in a new era of minimally invasive and intelligent surgery.Minimally invasive surgeries, such as small incision, percutaneous surgery, arthroscopic surgery, and endoscopic surgery, have contributed to less invasive surgical trauma, better cosmesis, and faster recovery. Furthermore, the recent adoption of artificial intelligence (AI) has introduced new assistances and tools for minimally invasive foot and ankle surgery. By the help of advanced AI algorithms, surgeons can accurately make diagnose and personalized treatment strategies. The application of computer-assisted navigation systems and robotics has facilitated precise surgical procedures and real-time confirmation of surgical outcomes. Foot and ankle surgery has lagged behind other surgical specialties in adopting these advancements. Currently, the integration of various forms of minimally invasive surgery and AI technology stands as the main trend in the development of foot and ankle surgery. It is believed that in the near future, intelligent minimally invasive surgery will become the mainstream in the domain of foot and ankle.
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NewsBot · Jul 14, 2024

Biomechanical consequences of proximal screw placement in minimally invasive surgery for hallux valgus correction
Dinesh SO Tamil Selven, BE et al
June 21, 2024

Hallux valgus is one of the most common surgically corrected forefoot deformities. Studies evaluating clinical outcomes of minimally invasive chevron and akin (MICA) procedure have shown shorter operation time, faster recovery, and smaller scars compared to the open approach. Previous biomechanical cadaveric studies have largely focused on the open approach with minimal on MICA. To our knowledge, no studies have compared different proximal screw placements in MICA which can either be three-point fixation or intramedullary. This study aims to compare the biomechanical properties of fixation between these two techniques in MICA. Six matched pairs of human fresh frozen cadaveric feet were randomized to either three-point fixation or intramedullary groups. Both procedures were performed by a single fellowship-trained orthopaedic foot and ankle surgeon. Using a material testing machine, each specimen underwent 1000 cycles of plantar-to-dorsal uniaxial loads from 0 to 31 N in cantilever configuration while monitoring bending stiffness and distal fragment dorsal angulation. They were then subjected to load until failure at a compression rate of 10 mm/min. Specimens from both groups tolerated the walking fatigue test. Mean bending stiffness of three-point fixation was 84% higher than intramedullary constructs (P=0.002). Mean dorsal angulation of intramedullary was thrice that of three-point fixation constructs (P=0.008). Mean load to failure of three-point fixation was 30% higher than intramedullary constructs (P=0.001). Three-point fixation provide superior biomechanical stability compared to intramedullary proximal screw placement. The surgical technique using three-point proximal screw fixation can offer robust fixation and lead to better clinical outcomes.
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NewsBot · Jul 16, 2024

Stability of Osteotomy in Minimally Invasive Hallux Valgus Surgery with "8" Shaped Bandage During Gait: A Finite Element Analysis
Xudong Sun Xudong Sun et al
Source

Introduction: Hallux valgus, a common foot deformity, often necessitates surgical intervention. This study evaluates the biomechanical alterations in patients post-surgery, focusing on the efficacy of an "8" bandage fixation system to promote optimal recovery. Methods:A three-dimensional (3D) model was constructed using CT data from a patient with hallux valgus. A quasi-static finite element analysis (FEA) was conducted in conjunction with gait analysis to evaluate the biomechanical changes at the osteotomy site under "8" shaped bandage fixation following hallux valgus surgery. The effects of the "8" shaped bandage on the stability of the osteotomy site and bone healing were investigated at three load points during the gait cycle. Results: During the Loading Response (LR), Midstance(MSt), and Terminal stance TSt phases, the osteotomy end experienced maximum Von Mises stresses of 0.118 MPa, 1.349 MPa, and 1.485 MPa, respectively. Correspondingly, the maximum principal stresses, all of which were compressive along the Z-axis, were 0.11662 N, 1.39266 N, and 1.46762 N, respectively. Additionally, these phases showed a maximum relative total displacement of 0.848 mm and a maximum relative shear displacement of 0.872 mm. Conclusion: During the stance phase, the osteotomy end of the first metatarsal is predominantly subjected to compressive stress, with the relative displacement within the safe range to promote healing. The application of an "8" bandage for external fixation after surgery can maintain the dynamic stability of osteotomy sites post-minimally invasive hallux valgus correction during the gait cycle, thereby promoting the healing of the osteotomy ends.
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NewsBot · Jul 17, 2024

Effectiveness of minimally invasive treatment of hallux valgus with small incision external articular osteotomy
Yang Zhang et al
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Jul 15;38(7):855-861.

Objective: To compare the effectiveness of small incision external articular minimally invasive osteotomy and traditional Chevron osteotomy in the treatment of hallux valgus.

Methods: A retrospective analysis was conducted on the clinical data of 58 patients (58 feet) with hallux valgus who were admitted between April 2019 and June 2022 and met the selection criteria. Among them, 28 cases were treated with small incision external articular minimally invasive osteotomy (minimally invasive group), and 30 cases were treated with traditional Chevron osteotomy (traditional group). There was no significant difference in baseline data such as age, gender, disease duration, Mann classification, and preoperative inter metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), forefoot width, tibial sesamoid position (TSP) score, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) score, psychological score (SF-12 MCS score) and physiological score (SF-12 PCS score) of short-form 12 health survey scale, and range of motion (ROM) of metatarsophalangeal joint between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, weight-bearing walking time, fracture healing time, and incidence of complications were recorded and compared between the two groups; as well as the changes of imaging indexes at last follow-up, and the clinical function score and ROM of metatarsophalangeal joint before operation, at 6 weeks after operation, and at last follow-up.

Results: All patients were followed up 11-31 months, with an average of 22 months. The incision length and intraoperative blood loss in the minimally invasive group were significantly less than those in the traditional group ( P<0.05), and the intraoperative fluoroscopy frequency and operation time in the minimally invasive group were significantly more than those in the traditional group ( P<0.05); but no significant difference was found in weight-bearing walking time and fracture healing time between the two groups ( P>0.05). There was 1 case of skin injury in the minimally invasive group and 3 cases of poor incision healing in the traditional group; all patients had good healing at the osteotomy site, and no complication such as infection, nerve injury, or metatarsal head necrosis occurred. At last follow-up, the imaging indexes of the two groups significantly improved when compared with those before operation ( P<0.05). The changes of DMAA and TSP score in the minimally invasive group were significantly better than those in the traditional group ( P<0.05), and there was no significant difference in the changes of IMA, HVA, and forefoot width between the two groups ( P>0.05). The clinical scores and ROM of metatarsophalangeal joint significantly improved in the two groups at 6 weeks after operation and at last follow-up when compared with preoperative ones ( P<0.05), and the indicators in the minimally invasive group were significantly better than those in the traditional group ( P<0.05).

Conclusion: Compared with traditional Chevron osteotomy, small incision external articular minimally invasive osteotomy can effectively improve HVA, IMA, and forefoot width, correct foot deformities, and has less trauma. It can better correct the first metatarsal pronation deformity and restore the anatomical position of the sesamoid bone, resulting in better effectiveness.
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NewsBot · Aug 4, 2024

Comparison of Minimally Invasive Chevron Akin and Open Lapidus Surgery in Older Patients at a Minimum 1-Year Follow-Up
Allison L Boden et al
Foot Ankle Orthop. 2024 Jul 30

Background: Hallux valgus deformity affects more than 35% of people aged ≥65 years. Surgical correction in this population can be more complicated because of poor bone quality, worse deformity, and postoperative recovery challenges. The purpose of this study was to compare the radiographic and clinical outcomes of patients aged ≥65 years who underwent either open Lapidus or minimally invasive chevron Akin osteotomy for bunion correction.

Methods: A retrospective review identified 62 patients aged ≥65 years who were treated surgically for hallux valgus with at least 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores (physical function and pain interference). Preoperative and at least 6-month postoperative radiographs were measured for the hallux valgus angle and intermetatarsal angle. PROMIS scores were obtained preoperatively and at 1 and/or 2 years postoperatively. Differences in demographic, clinical, and radiographic outcomes were assessed using the Mann Whitney U test and P values were adjusted for a false discovery rate of 5%.

Results: There was no difference between the MIS and open cohorts in pre- or postoperative radiographic measurements or clinical outcomes at any time point. At 1 year postoperatively, both groups had statistically significant improvements in the PROMIS pain interference domain but only the MIS group had a statistically significant improvement in the PROMIS physical function domain. Clinical significance was equivocal. At 2 years postoperatively, there were clinically and statistically significant improvements in the PROMIS pain interference and physical function domains for the open and MIS groups.

Conclusion: Patients in both surgical groups had improvement in radiographic measurements and 2-year PROMIS scores, although there was no clinical or statistical difference found between groups. MIS and open surgical techniques appear to be safe and effective in correcting hallux valgus in older patients; however, patients may need to be counseled that maximum improvement after surgery may take more than 1 year.
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NewsBot · Aug 4, 2024

A Novel Simulation Model and Training Program for Minimally Invasive Surgery of Hallux Valgus
Sergio Morales, Peter Lam, Rebecca Cerrato, Pablo Mococain, Cristián Ruz, Jorge Filippi, Andrés Villa, Julián Varas
J Am Acad Orthop Surg. 2024 Aug 15;32(16):e816-e825

Background: Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS.

Methods: A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage.

Results: Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280).

Discussion: Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters.

Conclusion: This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model.
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NewsBot · Aug 7, 2024

Clinical guideline on the third generation minimally invasive surgery for hallux valgus
Guangyi Li et al
Journal of Orthopaedic Translation Volume 45, March 2024

Minimally invasive surgery for hallux valgus correction, has been attracting great interests in the recent decades, due to the potential benefits of less pain, decreased recovery times, smaller scars with better cosmesis, and improved early post-operative range of motion. The most recent developments in minimally invasive surgery have evolved into the third generation with modifications of the chevron-type osteotomy. This evidence-based clinical guideline of the third generation minimally invasive surgery for hallux valgus is initiated and developed collectively by the Foot and Ankle Committee of Orthopedic Branch of Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Branch of Chinese Medical Doctor Association, and Foot and Ankle Expert Committee of Orthopedic Branch of the Chinese Association of the Integrative Medicine. This clinical guideline provides recommendations for indications, contraindications, operative planning and techniques, post-operative management, management of complications, and prognosis of the third generation minimally invasive surgery for hallux valgus.

The Translational Potential of this Article This comprehensive guideline aims to establish standardized recommendations for the indications, contraindications, operative techniques, and post-operative management of the third generation minimally invasive surgery for hallux valgus. By adhering to this guideline, the success rate of the procedure could be maximized. This comprehensive guideline serves as a valuable reference for practitioners interested in or preparing to perform minimally invasive surgery for hallux valgus.
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NewsBot · Aug 23, 2024

Clinical and radiological outcome of surgical hallux valgus correction: open versus minimally invasive
Andreas Pappas, Alexander Hönning, Marc D. Schmittner, Axel Ekkernkamp & Denis Gümbel
European Journal of Orthopaedic Surgery & Traumatology

Introduction
Hallux valgus (HV) is the most common forefoot deformity. Surgical correction of HV aims to reduce pain, preserve joints, and re-establish foot function while restoring the hallux valgus angle (HVA) and intermetatarsal angle (IMA). Many surgical procedures have been proposed, including open and minimally invasive (MI) techniques. This study aimed to compare the midterm outcomes of open vs. MI procedures and their impact on the duration of surgery, hospital stay, HVA, and IMA post-operatively.

Materials and methods
One hundred and twenty HV patients operated by open or MI surgery between October 2019 and October 2022 were included. One hundred three patients met the inclusion criteria and consented to the study. Patients were prospectively surveyed for foot functionality, post-operative pain, and complications using the AOFAS score. Radiographic measurements of HV angles, length of hospital stay, and surgery duration were analysed.

Results
MI surgery patients had significantly better AOFAS scores (p < 0.001) 12 months post-operatively compared to open surgery. Complication rates were lower in the MI group (3.8% vs. 33.3%, p < 0.001). MI surgery patients also had shorter hospital stays (0.9 ± 0.3 days vs. 2.0 ± 0.0 days) and surgery duration (19.7 ± 2.3 min vs. 80.7 ± 6.8 min). MI surgery was more effective in correcting the IMA but equally effective as open surgery for HVA correction.

Conclusion
MI surgery resulted in better patient satisfaction, fewer complications, and more precise correction of IMA values. Moreover, the duration of surgery and hospital stay were significantly lower in patients undergoing MI surgery. Further research is needed to validate these findings in controlled, prospective randomised trials.
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NewsBot · Sep 12, 2024

Biomechanical model of minimally invasive hallux valgus surgery
Yueyang Zhang et al
Comput Methods Biomech Biomed Engin. 2024 Sep 10:1-10.

Hallux valgus is a common foot deformity characterized by outward tilting and twisting of the big toe, often accompanied by a medial prominence at the base. Minimally invasive surgical techniques are widely utilized for treating metatarsus adductus due to their advantages of smaller incisions, faster recovery, and early weight-bearing. However, due to individual variations and limited sample size, the biomechanical effects of different Kirschner wire fixation methods and the underlying mechanisms of postoperative metatarsalgia remain unclear. In this study, a finite element method was employed to develop a biomechanical model of metatarsus adductus. The influence of various Kirschner wire entry points and angles on foot loading characteristics was investigated. Six different Kirschner wire fixation models, including two entry methods (along the adjacent fracture line and proximal-biased entry at the midshaft of the metatarsal) with different entry angles, were analyzed. Mechanical parameters such as metatarsal stress distribution, plantar pressure distribution, and displacement of the first metatarsal osteotomy plane were assessed. This research aims to enhance understanding of minimally invasive surgery and its fixation methods for metatarsus adductus. By providing scientific support and reliable evidence, it seeks to contribute to the development of minimally invasive surgical techniques and the improvement of clinical practice in metatarsus adductus surgery. Ultimately, the goal is to reduce complications, increase surgical success rates, and enhance patient satisfaction.
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NewsBot · Sep 22, 2024

Third generation versus fourth generation percutaneous hallux valgus correction: a radiographic analysis of outcomes
Brian G. Loder, DPM, FACFAS bloder1@hfhs.org ∙ Jason Lucas, DPM, AACFAS ∙ Megan Bergeron, DPM, AACFAS
Source

Percutaneous hallux valgus correction is gaining popularity with foot and ankle surgeons. A variety of studies have found that the percutaneous approach has increased patient satisfaction and outcomes. The technique of the procedure has some variability with the geometry of the distal osteotomy being the most scrutinized. As of this publication, there has been no comparative studies on the geometry of the distal metatarsal osteotomy. This is a retrospective study of 50 patients who underwent percutaneous correction of a hallux valgus deformity with either a percutaneous transverse or modified chevron osteotomy. The two groups were compared radiographically preoperatively and post operatively using both the intermetatarsal and hallux valgus angles. There is no difference in radiographic outcomes when comparing pre and post operative IM and HAV angles and it is the surgeon comfort levels with a particular geometry of the osteotomy that should determine the approach.
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NewsBot · Oct 2, 2024

Minimally Invasive vs Open First Ray Dorsiflexion Osteotomy: Radiographic Outcomes and Early Complications Report
Marium Raza et al
Foot Ankle Int. 2024 Sep 26:

Background: There is limited literature comparing open and minimally invasive surgical (MIS) techniques for first ray dorsiflexion osteotomy (DFO). This study is the first of its kind to report early healing and complication rates of patients undergoing MIS vs open first ray DFO.

Methods: A retrospective cohort review of 28 patients who underwent a first ray DFO procedure at an academic medical center between 2015 and 2024 was conducted. Demographic factors and medical comorbidities were recorded. Radiologic parameters were measured along with healing. Postoperative healing and outcomes were identified through medical record review.

Results: Thirteen open and 15 MIS DFO procedures were performed. At follow-up, all osteotomies were healed with no wound or infection complications. There was no significant difference in hardware removal rates, 7.7% for open and 6.7% for MIS. The change in lateral Meary angle was 10.5 ± 3.9 and 9.7 ± 4.3 for the open and MIS groups, respectively (P = .61). The calculated dorsal closing wedge resection was 3.5 mm and 4.1 mm for open and MIS, respectively (P = .26).

Conclusion: This study showed no significant differences in healing or complication rates in the short term between MIS and open surgery, with comparable magnitude of correction, suggesting similar ability for the MIS technique to correct first ray alignment. Further studies are needed to determine long-term outcomes.
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NewsBot · Oct 25, 2024

Radiographic and complication evaluation of 2 different bioresorbable pins in hallux valgus corrective surgery
B Vendeville, J Hennequin, J Cavailhès, A Fresse, L Galois
Acta Orthop Belg. 2024 Jun;90(2):261-269

Osteotomies to correct hallux valgus are usually secured using metal implants. Their main disadvantage is the need for a repeat surgery for removal of implanted material. Bioresorbable implants would make it possible to overcome this complication. Few studies analyse the results of using bioresorbable pins. The primary objective of this study is to compare hallux valgus correction radiographic results with the use of two types of bioresorbable pins. The secondary objectives are to screen for possible complications related to the use of these bioresorbable pins. This is a descriptive, retrospective, single-centre study carried out between May 2018 and May 2022 in the orthopaedic surgery department of the Centre Chirurgical Emile Gallé at the CHRU in Nancy (France). The study involved 105 hallux valgus (98 patients) operated on by open double metatarsal and phalangeal osteotomy. Osteotomies were stabilised with resorbable polylactic acid (PLLA) pins (Arthrex® TRIM-IT® drill pin) in 57 cases (53 patients), and with resorbable polylactic acid-polyglycolic acid copolymer (PGLA) pins (Bioretec® ActivaPins®) in 48 cases (45 patients). The efficacy of hallux valgus correction was analysed in terms of changes in preoperative and postoperative radiographic parameters at 1 and 6 months on a weight-bearing foot. Descriptive statistics were used to describe the demographic and radiological parameters of each group. The mean age was 59.7 years (range 25-81 years) in the PLLA group and 56 years (range 23-78 years) in the PGLA group. The mean preoperative HVA was 30° (range 15-63°) in the PLLA group and 30.8° (range 15-57°) in the PGLA group. The mean preoperative IMA was 14.4° (range 7-30°) in the PLLA group and 13.8° (range 7-20°) in the PGLA group. There was a statistically significant correction of hallux valgus in the PLLA (p=5.24 X 10-15 ) and PGLA (p=3.56 X 10-13 ) groups. The mean correction for the hallux valgus angle was 13° in the PLLA group and 12° in the PGLA group. There was no statistically significant difference in hallux valgus correction between the PLLA and PGLA groups, particularly in terms of hallux valgus severity. There was no radiological or clinical complication in the groups related to bioresorbable pins. The use of bioresorbable pins allows effective stabilisation of osteotomies to correct hallux valgus. There was no significant difference in correction between PLLA and PGLA implants, regardless of the severity of the hallux valgus. We did not observe any obvious clinical or radiological complications related to their use. The use of bioresorbable osteosynthesis material in forefoot surgery seems to offer interesting advantages, providing patients with safer and less invasive treatment solutions.
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NewsBot · Oct 27, 2024

Utilisation of the minimally invasive chevron akin (mica) osteotomy for severe hallux valgus: a systematic review
P. Ruberto, S. Calori, G. Bocchino, A. Giuliani, R. Vitiello, F. Forconi, G. Malerba & G. Maccauro
MUSCULOSKELETAL SURGERY

Background and aim
Hallux valgus is the most common forefoot disease that can cause pain and be disabling for the patient. Many surgical procedures have been described to correct this deformity; over the last years, the minimally invasive Chevron and Akin osteotomies (MICA) technique has become very popular. The aim of this review was to assess if MICA technique is a reliable procedure for treating severe hallux valgus.

Methods
A systematic review was performed according to the Preferred Reporting Items for systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed Medline and Cochrane library. To minimise the number of missed studies, no filters were applied to the search strategy. To be considered for this review, the articles needed to comply with the following inclusion criteria: Minimally invasive Chevron and Akin osteotomy (MICA) for severe hallux valgus (HVA > 40°, IMA > 16°), patient age over 18 years and minimum follow-up of 6 months.

Results
Following the PRISMA flow chart 7 studies met the inclusion criteria and were taken into consideration in the review. We reached a population of 582 patients for a total of 676 feet. Males and females were 64 and 518, respectively. The mean age was 54.15 ± 8.25. The mean follow-up was 23.74 ± 9.60 months. All the studies reported an improvement in clinical results, in terms of function and quality of life. Radiological variables, mostly IMA and HVA, assessed pre- and postoperatively showed significant improvement in all studies included.

Conclusions
Despite the limited number of published studies in the literature, the available evidence reveals good clinical outcomes and high levels of patient satisfaction. Percutaneous surgery for severe hallux valgus can achieve great deformity correction with reasonable rates of residual deformity. Patient satisfaction and quality of life following third-generation MICA surgery is very high.
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NewsBot · Nov 18, 2024

Characterization Of First Metatarsal Regeneration After New Modern Minimally Invasive Bunion Surgery. A Retrospective Radiographic Review Of 172 Cases.
Blitz NM, Wong DT, Grecea B, Baskin ES.
J Min Invasive Bunion Surg. 2024;1. doi:10.62485/001c.92756

Introduction
First metatarsal regeneration (FMR) is a new phenomenon that occurs as a result of new minimally invasive bunion surgery (MIBS) and has yet to be studied. The goal of this investigation is to characterize bone healing and introduce a new classification system (3 Types).

Methods
A retrospective radiographic review between January 2018 to June 2021 was performed, identifying 172 feet (122 patients). A minimum of four months of follow-up was required to be included. We classified the extent of callus formation based on the relationship to the primary “anchor” screw. A FMR Type I involved callus medial to the screw, FMR Type II involved callus medial and lateral to the screw, and FMR Type III had robust callus with first metatarsal regeneration.

Results
Mean age was 46.6±14.6 years; 117 (95.9%) females and 5 (4.1%) males. Mean follow-up was 8.2±5.7 months. The FMR bone healing distributions were Type I (17.4%, 30 feet), Type II (42.4%, 73 feet), and Type III (40.1%, 69 feet). There was a statistically significant overall difference in both IMA and HVA, (P<0.001), which was maintained across all FMR types (I-III, p<0.0001 for all comparisons). No statistical significant correlation between FMR type and age, sex, laterality, operation on both or one foot, length of follow-up, and pre- and postop radiographic angles. The same FMR type occurred in bilateral surgery in 28% when performed on the same day, and 20% on different days; and these differences were not statistically significant.

Conclusion
This is the first investigation to provide patterns of healing after MIBS, and evidence that FMR does occur for all bunion severities. Surgeons considering performing MIBS should no longer fear that bone healing is not possible. Our classification will help guide future studies by comparing the FMR with different techniques, fixation types/constructs and/or weight bearing protocols.
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NewsBot · Nov 28, 2024

Periarticular soft tissue effect following fourth generation MIS Hallux Valgus correction: Formation of a pyramid-shaped first metatarsal osseous healing zone
Ashley E. Spacek,et al
Source

Literature of fourth-generation minimally invasive surgery (MIS) on hallux valgus is scarce. In this study, extra-capsular transverse osteotomies were performed on ten cadaveric specimens. The capital fragment was shifted lateral to nearly 100% of the first metatarsal width and then fixated in contemporary fashion following MIS principles. A mixture of radio-opaque solution and methylene blue dye was injected through the second screw hole into the pyramid-shaped space created after the osteotomy shift. The injection was visualized under fluoroscopy and specimen were dissected in layered fashion to assess for containment versus extravasation. The purpose of this study is to observe and describe the preservation of the joint capsule, periosteum, and soft tissue structures adjacent to the osteotomy.
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NewsBot · Nov 28, 2024

TF and MFR on Calf Muscles in Patients With Pes Planus

Brief Summary
Pes planus, commonly known as flat feet, is a condition characterized by a reduced or absent arch in the foot, which often leads to pain and functional limitations. This study aims to evaluate the effectiveness of two therapeutic interventions-tissue flossing and myofascial release-in improving balance, arch height, and range of motion (ROM) in patients with flexible flatfoot. The research will be conducted at the Margalla Rehabilitation Center over a duration of six months, involving a total of 44 participants divided into two equal groups. One group will receive tissue flossing as the intervention, while the other group will undergo myofascial release. Participants will be selected using non-probability convenience sampling. Eligible individuals will be adults aged 18-25 years with flexible pes planus and limited ankle dorsiflexion. The study seeks to provide valuable insights into the comparative effectiveness of these interventions for managing symptoms associated with flat feet. Data was be analyzed through SPSS version 25.
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NewsBot · Dec 14, 2024

Refinement of Modified Endoscopic Lateral Soft-Tissue Procedure for Correction of Hallux Valgus Deformity
Tun Hing Lui et al
Source

Hallux valgus is a common orthopaedic problem, and surgical correction frequently is indicated for symptomatic deformity. The modified endoscopic distal soft-tissue procedure has been reported to provide a minimally invasive approach of hallux valgus correction with augmentation of the medial metatarsosesamoid suspensory ligament and intermetatarsal ligament. The purpose of this Technical Note is to describe the refinements of the modified endoscopic distal soft-tissue procedure to achieve more anatomical augmentation of the medial metatarsosesamoid ligament and intermetatarsal ligament, which can provide more stable reconstruction and prevent stiffness of the first metatarsophalangeal joint.
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NewsBot · Dec 23, 2024

The management of non-union following minimally invasive bunion surgery
Gil Genuth M.D.
Foot & Ankle Surgery: Techniques, Reports & Cases

As the use of minimally invasive surgery (MIS) becomes more prevalent for the correction of hallux valgus deformity, there is increased information on complications following the procedure, including non-union. However, there remains a gap in literature relating to the management of symptomatic non-union following MIS. This retrospective, multicenter study investigates the incidence, risk factors, and outcomes of symptomatic non-union following MIS bunion surgery. Among four orthopedic institutions, 17 cases of symptomatic non-union were identified after MIS bunion surgery between June 2018 and January 2024, representing an estimated prevalence rate of 0.3%. Risk factors including smoking, Vitamin D deficiency, and comorbidities such as diabetes and Lyme disease were noted in some cases, although no obvious risk factors were found to contribute to the development of non-union after MIS bunion surgery performed using a distal metatarsal osteotomy and proximal phalanx osteotomy as described by Redfern and Vernois1. Both open and MIS approaches were employed for revision surgeries, with 67% performed as open surgeries. 14 of 17 (82%) non-union cases achieved complete healing following revision surgery, with an average time to union of 11 weeks. This study highlights both open and MIS techniques as preliminary treatment protocols for symptomatic non-union following MIS bunion surgery, providing guidance for surgeons on how to manage this rare, but challenging, complication.
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NewsBot · Dec 26, 2024

Effectiveness of minimally invasive treatment of hallux valgus with small incision external articular osteotomy
Yang Zhang et al
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Jul 15;38(7):855-861

Objective: To compare the effectiveness of small incision external articular minimally invasive osteotomy and traditional Chevron osteotomy in the treatment of hallux valgus.

Methods: A retrospective analysis was conducted on the clinical data of 58 patients (58 feet) with hallux valgus who were admitted between April 2019 and June 2022 and met the selection criteria. Among them, 28 cases were treated with small incision external articular minimally invasive osteotomy (minimally invasive group), and 30 cases were treated with traditional Chevron osteotomy (traditional group). There was no significant difference in baseline data such as age, gender, disease duration, Mann classification, and preoperative inter metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), forefoot width, tibial sesamoid position (TSP) score, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) score, psychological score (SF-12 MCS score) and physiological score (SF-12 PCS score) of short-form 12 health survey scale, and range of motion (ROM) of metatarsophalangeal joint between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, weight-bearing walking time, fracture healing time, and incidence of complications were recorded and compared between the two groups; as well as the changes of imaging indexes at last follow-up, and the clinical function score and ROM of metatarsophalangeal joint before operation, at 6 weeks after operation, and at last follow-up.

Results: All patients were followed up 11-31 months, with an average of 22 months. The incision length and intraoperative blood loss in the minimally invasive group were significantly less than those in the traditional group ( P<0.05), and the intraoperative fluoroscopy frequency and operation time in the minimally invasive group were significantly more than those in the traditional group ( P<0.05); but no significant difference was found in weight-bearing walking time and fracture healing time between the two groups ( P>0.05). There was 1 case of skin injury in the minimally invasive group and 3 cases of poor incision healing in the traditional group; all patients had good healing at the osteotomy site, and no complication such as infection, nerve injury, or metatarsal head necrosis occurred. At last follow-up, the imaging indexes of the two groups significantly improved when compared with those before operation ( P<0.05). The changes of DMAA and TSP score in the minimally invasive group were significantly better than those in the traditional group ( P<0.05), and there was no significant difference in the changes of IMA, HVA, and forefoot width between the two groups ( P>0.05). The clinical scores and ROM of metatarsophalangeal joint significantly improved in the two groups at 6 weeks after operation and at last follow-up when compared with preoperative ones ( P<0.05), and the indicators in the minimally invasive group were significantly better than those in the traditional group ( P<0.05).

Conclusion: Compared with traditional Chevron osteotomy, small incision external articular minimally invasive osteotomy can effectively improve HVA, IMA, and forefoot width, correct foot deformities, and has less trauma. It can better correct the first metatarsal pronation deformity and restore the anatomical position of the sesamoid bone, resulting in better effectiveness.
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NewsBot · Jan 1, 2025

Current concepts of fourth-generation minimally invasive and open hallux valgus surgery
Thomas L Lewis et al
Bone Joint J. 2025 Jan 1;107-B(1):10-18.

Hallux valgus (HV) presents as a common forefoot deformity that causes problems with pain, mobility, footwear, and quality of life. The most common open correction used in the UK is the Scarf and Akin osteotomy, which has good clinical and radiological outcomes and high levels of patient satisfaction when used to treat a varying degrees of deformity. However, there are concerns regarding recurrence rates and long-term outcomes. Minimally invasive or percutaneous surgery (MIS) has gained popularity, offering the potential for similar clinical and radiological outcomes with reduced postoperative pain and smaller scars. Despite this, MIS techniques vary widely, hindering comparison and standardization. This review evaluates the evidence for both open Scarf and Akin osteotomy and newer-generation MIS techniques. Fourth-generation MIS emphasizes multiplanar rotational deformity correction through stable fixation. While MIS techniques show promise, their evidence mainly comprises single-surgeon case series. Comparative studies between open and MIS techniques suggest similar clinical and radiological outcomes, although MIS may offer advantages in scar length and less early postoperative pain. MIS may afford superior correction in severe deformity and lower recurrence rates due to correcting the bony deformity rather than soft-tissue correction. Recurrence remains a challenge in HV surgery, necessitating long-term follow-up and standardized outcome measures for assessment. Any comparison between the techniques requires comparative studies. Surgeons must weigh the advantages and risks of both open and MIS approaches in collaboration with patients to determine the most suitable treatment.
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NewsBot · Jan 10, 2025

Results of Modified Minimally Invasive Hallux Valgus Surgery, Factors for the First Metatarsal Shortening, and Patients' Satisfaction
Jihyun Hwang et al
J Clin Med. 2024 Dec 22;13(24):7840.

Background: Hallux valgus is a prevalent foot deformity conventionally treated with open surgical techniques, which carry risk of complications due to extensive soft tissue dissection. Minimally invasive surgeries (MISs) as alternatives offer comparable outcomes, reduced pain, and faster recovery; however, their challenges include the risk of shortening of the first metatarsal. This study aimed to assess the efficacy of our modified MIS hallux valgus correction technique and investigate the factors that affect first metatarsal shortening. Methods: Twenty-nine feet treated with modified MIS hallux valgus surgery between 2017 and 2022 were included with an average follow-up of 29 months. Clinical outcomes were evaluated with the Manchester-Oxford Foot Questionnaire (MOXFQ), Foot Function Index (FFI), and visual analog scale for pain. Radiographic evaluations included the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsal length, and sesamoid grade. Results: Functional and radiographic outcomes were significantly improved (p < 0.0001 and p < 0.001, respectively). Significant correlations between patient satisfaction and the MOXFQ, FFI, and VAS scores were found, with no significant correlations between patient satisfaction and radiographic outcomes. Non-purchasing of the lateral cortex of the proximal osteotomy site was identified to increase risk of first metatarsal shortening (odds ratio [OR] = 22.09, p = 0.0064). Conclusions: Our modified MIS for hallux valgus correction showed favorable radiographic and functional outcomes. Proximal lateral cortex purchasing should be targeted to reduce postoperative shortening of the first metatarsal.
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Minimally invasive surgery for hallux valgus

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Minimally invasive surgery for hallux valgus

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Two weeks after minimally invasive surgery toe problems

Minimally invasive surgery to treat interdigital helomas

Minimally invasive surgery for pedal digital deformity

Minimally invasive surgery for plantar fasciitis

Minimally invasive forefoot surgery - a cadaveric study

Percutaneous minimally invasive surgery for HV

Minimally invasive procedure for metatarsal osteotomy

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