Minimally invasive surgery for hallux valgus

NewsBot · Oct 1, 2025

Surgical Correction of Severe Hallux Abducto-Valgus Deformity with Minimally Invasive Chevron Akin Osteotomy: A Systematic Review
Levi Smith DPM et al
Foot & Ankle Surgery: Techniques, Reports & Cases 27 September 2025, 100574

Background
With the increasing use of minimally invasive surgical (MIS) techniques in the field of hallux abductovalgus (HAV) correction, foot and ankle surgeons are utilizing third-generation techniques, such as the minimally invasive chevron Akin (MICA) osteotomy, to repair bunions ranging in severity from mild to severe. Literature identifying the correction of severe HAV deformities with MIS techniques is sparse.
Purpose
We therefore conducted a systematic review of peer-reviewed sources to analyze complications, pre- and postoperative radiographic analysis, and patient-reported outcomes in correction of severe HAV deformity with the MICA surgical approach.
Study Design/Methods
After review of multiple databases, we obtained 4 articles matching our inclusion criteria, with 236 total feet.
Results
Complication rates ranged from 18.8% to 24.2%, while recurrence rates ranged from 3.8% to 7.5%. Average intermetatarsal angle improved from 17.81 degrees to 6.59 degrees, and hallux valgus angle improved from 42.18 degrees to 8.94 degrees. Improvements in the two radiographic angles were statistically significant. Improvement in patient-reported outcomes was appreciated among studies but unable to be analyzed statistically owing to low sample size and heterogeneity in reporting.
Conclusion
Our systematic review revealed that the use of the MICA technique to correct severe HAV deformity showed significant improvement of radiographic angles, acceptable patient-reported outcomes, and complication and recurrence rates similar to those reporting on less severe deformity correction.
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NewsBot · Nov 18, 2025

Guided Percutaneous Hallux Valgus Surgery: Advancing Into the Future With the Fourth-Generation Technique. Outcomes and Complications
David Campillo-Recio et al
Foot Ankle Spec. 2025 Nov 18:19386400251382286.

BackgroundThe aim of this study is to describe the surgical technique, outcomes, and complications associated with fourth-generation percutaneous hallux valgus correction using a guided system.MethodsProspective case series of 28 patients, aged 16 and older (5 men and 23 women), averaging 56.89 years, who underwent surgery for hallux valgus with at least 12 months of follow-up.ResultsThe preoperative American Orthopaedic Foot & Ankle Society (AOFAS)-hallux score increased from 63.8 to 89.7 (P < .001) at 12 months post-surgery. The visual analog scale (VAS) score decreased from 6 to 0.16 (P < .001) in the same period. The preoperative intermetatarsal angle (IMA) decreased from 13.38° to 2.72° (P < .001) post-surgery, while the Hallux valgus angle (HVA) decreased from 23.01° to 5.2° (P < .001). There were 3 complications including 1 superficial wound infection, 1 malpositioning of the screws and 1 hypertrophic non-union.ConclusionThe described percutaneous hallux valgus surgery appears to be reliable, with consistent improvements in clinical outcomes and radiological results. The guided technique is promising in order to reduce common complications.
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NewsBot · Nov 23, 2025

Outcomes and Complications for Minimally Invasive Distal Transverse Metatarsal Osteotomy–Akin Osteotomy (MITA) for Hallux Valgus: 493 Cases
Journal of Orthopaedic Surgery and Research

Background

Hallux valgus is one of the most common forefoot deformity, leading to impaired mobility and reduced quality of life. Minimally invasive surgical techniques offer potential advantages, including reduced soft tissue disruption and accelerated postoperative recovery. The present study aimed to assess the clinical and radiographic outcomes of Minimally Invasive Distal Transverse Metatarsal Osteotomy combined with Akin Osteotomy (MITA) in a large patient cohort.
Methods

A retrospective review was performed on 493 feet treated with MITA between March 2020 and December 2021 at a single orthopedic center. Radiographic parameters—including hallux valgus angle (HVA), intermetatarsal angle (IMA), sesamoid position, and foot width—were evaluated preoperatively and at multiple postoperative points up to one year. Clinical outcomes were assessed by the Visual Analog Scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Manchester-Oxford Foot Questionnaire (MOXFQ), including each domain. Complications were classified into three grades according to severity. Statistical analysis included paired t-tests and repeated measures using a general linear model.
Results

Significant improvements were demonstrated across all radiographic and clinical parameters. Mean HVA decreased from 34.24° to 8.38°, and IMA from 12.67° to 5.78° (p < 0.001). Cases with grade 3 sesamoid displacement decreased markedly, from 424 to 5. Clinical outcomes also improved substantially: VAS scores declined from 2.91 to 0.20, AOFAS scores increased from 82.20 to 99.11, and MOXFQ scores decreased from 36.02 to 4.39 (all p < 0.001). The majority of complications were minor (Grade 1), with transient neurapraxia being the most frequent (6.0%). Severe complications (Grade 3) were uncommon and manageable.
Conclusions

MITA provides effective correction of hallux valgus, achieving excellent radiographic alignment and favorable clinical outcomes. Its minimally invasive approach facilitates rapid postoperative recovery and is associated with a low complication profile, supporting its role as a viable alternative to conventional open procedures and previous generation MIS techniques.
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NewsBot · Nov 29, 2025

Multimodal evaluation of partial zig-zag tenotomy of the extensor hallucis longus in minimally invasive hallux valgus surgery: a randomized trial
V Sanchís-Soria et al
J Orthop Surg Res. 2025 Nov 28.

Background: Hallux abductus valgus (HAV) is a common, complex forefoot deformity with significant clinical and functional implications. While minimally invasive surgery (MIS) often results in better recovery and improved cosmetic outcomes, adjunctive procedures such as zig-zag tenotomy of the extensor hallucis longus (EHL) tendon remain poorly documented. This study aims to evaluate the clinical, structural, and functional outcomes of MIS with and without EHL tenotomy in patients with moderate to severe HAV.

Methods: This was a prospective, randomized, controlled, single-blind clinical trial conducted in a private clinic in Alicante, Spain, between February 2024 and June 2025. Adults aged 20-90 years with moderate/severe HAV and hallux hyperextension were randomized (ABBA sequence, concealed by independent investigator) to MIS with zig-zag EHL tenotomy (n = 25) or MIS without tenotomy (n = 21). Both groups underwent Reverdin-Isham and Akin osteotomies plus adductor tenotomy.

Primary outcome: change in the hallux valgus angle (HVA) at 12 months.

Secondary outcomes: changes in PASA, IMA, DASA, MPA, IPA, mean and peak plantar pressure (static baropodometry, S-Plate®), and AOFAS score. Intra- and intergroup differences were analyzed using t-tests and repeated-measures ANOVA, reporting p-values and effect sizes (Cohen's d, 95% CI).

Results: Of 49 patients assessed, 46 were randomized (4 men, 42 women; mean age 62.0 ± 13.6 years). At 12 months, both groups improved significantly in HVA: tenotomy group - 18.2° (95% CI - 21.9 to - 14.5; d = 1.73; p < 0.001) vs. no-tenotomy - 16.9° (95% CI - 21.5 to - 12.3; d = 1.83; p < 0.001), with no significant between-group difference. The tenotomy group showed greater reductions in PASA (- 5.68°, d = 1.12), IMA (- 4.16°, d = 1.30), and IPA (- 12.17°, d = 1.20). Mean plantar pressure increased significantly only in the tenotomy group (+ 18.7 g/cm2; p = 0.04). Peak plantar pressure remained unchanged in both groups. AOFAS scores improved significantly and similarly in both groups (time*group interaction, p = 0.38).

Conclusions: In moderate/severe HAV, adding zig-zag EHL tenotomy to MIS may provide additional benefits in radiographic correction and plantar load redistribution without impairing functional recovery. These findings support its use in complex deformities or high tendon tension, though longer-term follow-up is needed to assess stability and recurrence.
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NewsBot · Nov 30, 2025

Functional Recovery and Return to Duty Following Minimally Invasive Surgery for Hallux Valgus: A Retrospective Review in Active-Duty Military Personnel
Colin Mizuo et al
Source

Background:
Hallux valgus can severely limit physical function in demanding professions like military service. Traditional open surgeries have shown limited success in achieving rapid recovery and full functional return. The primary objective of this study was to assess functional outcomes of active-duty service members who have undergone minimally invasive bunion surgery.
Methods:
Eighteen active-duty service members with mild to moderate hallux valgus deformities who underwent minimally invasive bunion correction between 2020 and 2022 were retrospectively reviewed.
Results:
Minimally invasive bunion surgery demonstrated significant improvements in self-reported outcomes of the Foot and Ankle Outcome Scores from pre- to post-procedure (total score: 57.0 vs 95.0 respectively, P > .001) including all subscales of symptoms, pain, activities of daily living, sports and quality of life. Additionally, radiographic analyses revealed marked corrections pre- to post-procedure in intermetatarsal angle (12.0 vs 7.5 degrees, P < .001), hallux valgus angle (25.5 vs 12.0 degrees, P < .001), and tibial sesamoid position (5.0 vs 2.0 degrees, P < .001), with 12 of 13 patients achieving full bone consolidation by their 6-month follow-up. Complications were minimal, with only 1 case requiring further intervention. Approximately half of the patients (8/18) did not require any limited duty, and 13 of 18 remained on active duty at final follow-up (median of 13 months).
Conclusion:
These findings underscore the potential of minimally invasive surgery in high-impact populations, although further research with larger cohorts is recommended to confirm long-term outcomes and functional durability in high-stress settings.
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NewsBot · Dec 2, 2025

Biomechanical comparison of five fixation methods in minimally invasive hallux valgus osteotomy: a three-dimensional finite element analysis
Xiaomei Li et al
Front Med (Lausanne). 2025 Nov 4:12:1701147.

Objective: Although minimally invasive osteotomy for hallux valgus employs a variety of internal fixation methods, systematic biomechanical evidence evaluating the stability and strength of different fixation configurations is lacking. This study aimed to quantitatively compare the biomechanical properties of five internal fixation techniques using three-dimensional finite element analysis.

Methods: Based on CT data of the foot of an adult female patient with moderate hallux valgus (HVA 27.6°, IMA 12.4°), a finite element model of the post-osteotomy state was constructed. The following fixation schemes were simulated: Group A: two 3.5 mm beveled metal screws; Group B: one 3.5 mm beveled metal screw; Group C: two 2.0 mm Kirschner wires; Group D: one 3.5 mm beveled metal screw and one 2.0 mm Kirschner wire; Group E: three 2.0 mm Kirschner wires. Comparison parameters included the maximum equivalent (Von-Mises) stress between the osteotomy fragment and the internal fixation, the maximum displacement of the osteotomy fragments in the X, Y, and Z axes, and the overall displacement of the internal fixation.

Results: Under the same load: 1. Maximum stress of the osteotomy fragment: Group A (5.6824 MPa) < Group B < Group D < Group C < Group E (33.33 MPa); 2. Maximum stress of internal fixation: Group A (16.159 MPa) < Group D < Group B < Group C < Group E (238.68 MPa, with significant stress concentration); 3. Maximum displacement of the osteotomy fragment (X/Y/Z): Group E (4.2035/2.8512/7.1309 mm) < Group D < Group A < Group C < Group B (4.3251/3.2353/7.4102 mm); 4. Overall displacement of internal fixation: Group B (7.5284 mm) < Group D < Group C < Group A < Group E (7.9256 mm).

Conclusion: 1. Two 3.5 mm beveled screws (Group A) are the optimal configuration, combining low stress distribution (lowest stress on the osteotomy fragment and internal fixation) with high stability (moderate displacement); 2. Combined fixation (Group D) is a secondary option, but bone quality assessment is required (Kirschner wire fixation carries the risk of loosening); 3. Three Kirschner wires (Group E) are only suitable for low-load cases due to the risk of high stress concentration (238.68 MPa).
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NewsBot · Dec 12, 2025

Economic Feasibility of Routine First Postoperative Radiographs in Minimally Invasive Bunion Surgery
Taylor Schnepp et al
Foot Ankle Orthop. 2025 Dec 8;10(4):24730114251388084.

Background: Orthopaedic surgical interventions are often costly, not only due to the procedures themselves, but also due to the need for frequent follow-up and imaging tests. Recent orthopaedic literature across several subspecialties has produced evidence suggesting that routine immediate postoperative radiographs do not provide any clinical advantage to justify their costs. This study aims to evaluate the economic feasibility of first postoperative radiographs after minimally invasive (MIS), fourth-generation MIS transverse double osteotomy for treatment of hallux valgus.

Methods: We retrospectively evaluated patients with hallux valgus treated with fourth-generation MIS transverse double osteotomy between January 2019 and December 2021. Medical records were reviewed to assess changes in management following initial radiographs taken on average 1.38 ± 0.83 weeks after surgery. Direct costs of radiographs at the first postoperative visit (FPOV) were estimated using 2025 Medicare Fee Schedule data (HCPCS Code 73630), United Healthcare cost estimator website (zip code 33146), and multiple locally available public self-pay resources. National costs were estimated using Medicare data for the estimated 110,000 to 220,000 annual bunion procedures performed in the United States.

Results: A total of 245 patients were included in our analysis. Four patients (1.6%, 95% CI 0.64%-4.12%) had an FPOV radiographic finding that warranted a change in management. Reasons included 1 (0.4%) loss of reduction of the first metatarsal osteotomy, 1 (0.4%) fracture through the Akin proximal phalanx osteotomy, and 2 (0.8%) subluxations of lesser toes fixated via K-wire. The cost per 3-view radiograph of the foot ranged from $31.68 to $106, depending on provider and payment type. National costs of routine radiographs for MIS bunion were estimated to be between $3.5 million to $23.3 million annually.

Conclusion: Routine radiographs after fourth-generation MIS transverse double osteotomy surgery at FPOV rarely result in a change of management. In patients without clinically visible signs or symptoms warranting intervention, radiographs in the FPOV are rarely justified for MIS bunionectomy patients. We recommend physical evaluation at FPOV but suggest that substantial health care expenses could be saved by removing unnecessary FPOV radiographic analysis.
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NewsBot · Dec 12, 2025

Lesser Metatarsals Load after Minimally-Invasive Surgery for Hallux Valgus Correction: A Finite Element Model
Henrique Mansur et al
Rev Bras Ortop (Sao Paulo). 2025 Dec 10;60(5):s00451813000.

Objective: To analyze the biomechanical consequences on the lesser metatarsals using different screw configurations for fixation of the minimally-invasive Chevron-Akin (MICA) osteotomy, through the finite element method (FEM).

Methods: A FEM model was developed from a computed tomography scan of a moderate HV deformity. Five different screw configurations were tested. We measured the maximal tension in the lesser metatarsals for each screw configurations, in physiological and supraphysiological loads.

Results: The lesser metatarsals received the lowest loads when the first metatarsal osteotomy was fixed with one intramedullary and one bicortical screw, with tensile load values varying between 30 and 70 MPa in physiological loads, and 50 to 350 MPa in supraphysiological loads. In all fixing techniques, the 2nd and 4th metatarsals received the highest loads, especially in groups 3 (2 bicortical screws) and 5 (only 1 bicortical screw), with values reaching up to 230 and 600 MPa in physiological and supraphysiological loads, respectively. Regardless of the fixation technique, the region of the lesser metatarsals that received the most load was the diaphysis.

Conclusion: After MICA surgery to correct HV, there is an increase in tension forces on the lesser metatarsals, especially the second and fourth. The technique of fixing the first metatarsal with one bicortical and one intramedullary screw showed the lowest values on the lesser metatarsals load. Furthermore, for physiological and supraphysiological loads, independently of the technique, the forces were concentrated mainly on the metatarsal shaft.
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NewsBot · Dec 20, 2025

Learning Curve for Minimally Invasive Surgery (MIS) for the Treatment of Hallux Valgus
Chase Gauthier et al
Foot Ankle Spec. 2025 Dec;18(6):661-667.

IntroductionCorrection of hallux valgus through minimally invasive surgery (MIS) has grown in popularity in recent years. Despite the increase in use, there has been limited research into the learning curve associated with the procedure, which has been documented extensively for other MIS procedures. Our study looked to determine the learning curve associated with MIS hallux valgus surgery.MethodsA retrospective review was conducted of patients who underwent MIS hallux valgus surgery, performed by 2 foot and ankle fellowship-trained orthopaedic surgeons, between November 2021 and April 2023. Demographic information, procedure data, and postoperative data were collected for each patient. A multivariable analysis was conducted for each surgeon to determine the relationship between case number and operative duration, patient-reported outcomes, and complications. Findings were significant if P < .05.ResultsCase number was found to have a significant negative relationship with operative duration for both of our surgeons (β = -0.578, -0.736, R2 = 0.637, 0.426, P < .001, .02). There was no significant relationship between case number and patient-reported outcomes (P = .49, .408) or complications (P = .319, .387) for either surgeon.ConclusionWe established the presence of a learning curve for operative duration, but not for patient-reported outcomes or complications. Overall, our results are conflicting regarding the presence of a learning curve for MIS hallux valgus procedures. Further study with other institutions is needed to further elucidate the presence of a learning curve
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NewsBot · Dec 29, 2025

One Versus Two Screw Fixation in Minimally Invasive Hallux Valgus Surgery: A Systematic Review
Thomas L Lewis et al
Cureus. 2025 Nov 27;17(11):e97907.

Minimally invasive surgery (MIS) for hallux valgus has evolved significantly, with ongoing debate about optimal fixation methods. Fourth-generation techniques typically use two metatarsal screws; however, single screw fixation may reduce operative time, radiation exposure, and cost. This systematic review compares clinical outcomes, radiographic results, and complications between one- and two-screw metatarsal fixation in minimally invasive hallux valgus correction. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted across MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to March 2025. Studies comparing single versus two screw fixation in minimally invasive hallux valgus surgery were included. Risk of bias was assessed using the Risk Of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Primary outcomes included radiographic parameters (Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA)) and clinical outcomes (American Orthopaedic Foot & Ankle Society Score (AOFAS), Visual Analog Scale (VAS), Manchester-Oxford Foot Questionnaire (MOXFQ)). Secondary outcomes included operative details, complications, and revision surgery rates. Five studies met inclusion criteria: two clinical (n = 153 patients, 162 feet) and three biomechanical studies. Clinical studies showed comparable radiographic correction and patient-reported outcomes between fixation methods. Single screw fixation demonstrated significantly shorter operative time and reduced fluoroscopy exposure. Hardware-related complications requiring removal were higher in two-screw groups (32% vs. 3% in one study; 1.9% vs. 0% in another). Biomechanical studies revealed that single screw fixation may provide insufficient rotational stability, while two-screw configurations demonstrated improved construct stability. Current evidence suggests that single screw fixation may reduce radiation exposure, surgical time, and hardware removal rates, but offers reduced biomechanical stability compared to a two-screw construct in patients undergoing minimally invasive hallux valgus surgery. However, the high risk of bias, limited comparative data, methodological heterogeneity, and relatively short follow-up periods in existing studies preclude definitive conclusions. Current evidence is insufficient to establish definitive recommendations, and fixation strategy should be individualised based on deformity characteristics and patient factors.
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NewsBot · Dec 31, 2025

Beyond the Numbers: Contextualizing High Recurrence Rates in Minimally Invasive Hallux Valgus Surgery

NewsBot · Dec 31, 2025

Relationship Between Metatarsal Head Translation and Unintended Increase in Diaphyseal-Intermetatarsal Angle in MICA Technique for Hallux Valgus Correction: A Retrospective Study
Daniele Marcolli et al
Foot Ankle Spec. 2025 Oct 19:19386400251374962.

ObjectivesThe aim of this study is to retrospectively analyze patients who underwent hallux valgus correction surgery using the Minimally Invasive Chevron and Akin (MICA) technique and assess the degree of metatarsal head translation, preoperative and postoperative inter-metatarsal angle (IMA), and postoperative diaphyseal-intermetatarsal angle (D-IMA). The hypothesis of this study is that, following hallux valgus correction using the MICA technique, an undesired increase in D-IMA may occur and that this increase is directly correlated with the percentage of first metatarsal head translation.Materials and MethodsIn total, 20 patients who underwent hallux valgus correction with the MICA technique were analyzed. Preoperative and postoperative dorso-plantar weight-bearing x-rays of the feet were evaluated: preoperative and postoperative IMA, postoperative D-IMA, and the percentage of metatarsal head translation were calculfasated. The Pearson correlation coefficient was calculated to assess the relationship between metatarsal head translation and the increase in postoperative D-IMA.ResultsThe difference between preoperative IMA and postoperative D-IMA was statistically significant with P < .0001. From preliminary analysis, it has emerged that the relationship is linear and the increase in D-IMA is directly correlated with the degree of metatarsal head translation, r = .83.ConclusionFrom this initial retrospective analysis, it emerges that despite the recognized effectiveness of the MICA technique in correcting hallux valgus and reducing IMA, a portion of metatarsal head translation does not lead to a decrease in IMA but rather to an increase in D-IMA. This study suggests a positive linear correlation between the percentage of metatarsal head translation and the increase in D-IMA.
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NewsBot · Jan 4, 2026

Minimally invasive chevron osteotomy provides comparable outcomes to open surgery for hallux valgus: A systematic review and meta-analysis
Alexander Tham et al
Foot Ankle Surg. 2025 Nov 25:S1268-7731(25)00267-X.

Background: Minimally invasive surgery (MIS) chevron osteotomy has emerged as an alternative to the traditional open chevron (OC) osteotomy for hallux valgus correction, aiming to achieve similar deformity correction with reduced soft-tissue trauma and faster recovery. However, the relative clinical and radiographic outcomes of these techniques remain debated.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and Cochrane databases were searched through June 2025 for randomized controlled trials (RCTs) and cohort studies comparing MIS and OC osteotomies in patients with hallux valgus. Only studies explicitly describing a percutaneous, burr-based V-shaped Chevron osteotomy were included. Primary outcomes included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Visual Analog Scale (VAS) pain scores, radiographic parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) and complication rates. Random-effects meta-analyses were performed, with subgroup analyses at early (≤6 months), mid-term (6-12 months), and long-term (>12 months) follow-ups.

Results: Six studies (3 RCTs, 1 prospective, 2 retrospective) comprising 342 patients (352 feet) were included. MIS chevron osteotomy demonstrated no significant differences compared with OC in postoperative AOFAS, VAS scores, HVA correction, or DMAA correction at any follow-up. Early postoperative VAS scores favored MIS, while postoperative and corrected IMA values at selected time points favoured open Chevron. However, all differences were small in magnitude and unlikely to be clinically meaningful. Complication rates were comparable between the techniques (OR 2.10, 95 % CI 0.82-5.40, p = 0.12, I2=23 %).

Conclusion: This systematic review and meta-analysis demonstrate that MIS Chevron osteotomy provides clinical and radiological outcomes comparable to those of open Chevron osteotomy. Differences in pain scores, angular correction, and complication rates were small and not clinically meaningful. These findings suggest that MIS Chevron is a safe and effective alternative to open Chevron osteotomy.
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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

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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

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