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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NewsBot · Feb 26, 2026

Pain Assessment in Hallux Valgus Surgery: A Comparison Between Minimally Invasive Transverse osteotomy and Akin (META) and Open Scarf and akin
Mario López et al
Source

Background
Hallux valgus is associated with pain, functional limitation and reduced life quality. Percutaneous surgical techniques with multimodal analgesia have emerged as alternatives to conventional approaches. Some studies suggest that percutaneous techniques result in less pain than open surgery.
Purpose
To compare rescue analgesic use and postoperative pain between the Scarf and META techniques in patients undergoing hallux valgus surgery.
Methods
A prospective cohort comprising two matched groups of patients who underwent hallux valgus surgery with either the Scarf or META technique was conducted. The same anesthetic and analgesic protocol was used in both groups. Pain was assessed using the Visual Analog Scale (VAS). Surveys were administered daily from postoperative day 1 to 7 and weekly from the second to the sixth week. Rescue analgesia (opioids) was also recorded.
Results
53 patients were enrolled: 28 in the META and 25 in the Scarf osteotomy group; demographic data were similar between groups. On postoperative day 1, VAS pain was 0.5 (0–2) in the META group and 2 (0–5) in the Scarf group. On day 2, it was 1 (0–2) and 7.1 (3–10), respectively. By week 6, pain were similar in both groups. Opioid use was higher in the open group . Differences in pain and analgesic use were statistically significant (p < 0.05).
Conclusion
The percutaneous group required lower doses of analgesia and reported less pain than the open technique, particularly during the first two postoperative weeks.
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NewsBot · Mar 6, 2026

Risk factors for first metatarsal fracture in minimally invasive hallux valgus surgery : a case-control study
Gabriel Ferraz Ferreira et al
Bone Joint J. 2026 Mar 1;108-B(3):361-368.

Aims: Minimally invasive hallux valgus (HV) correction techniques, including minimally invasive chevron and Akin osteotomy (MICA) and metaphyseal extra-articular transverse and Akin osteotomy (META), offer favourable outcomes but are associated with unpredictable first metatarsal fractures. This study identifies predictive factors for first metatarsal fractures following minimally invasive HV surgery.

Methods: This retrospective case-control study analyzed 370 patients (499 feet) who underwent minimally invasive HV correction between November 2017 and August 2024 at a tertiary orthopaedic centre. Cases from the learning curve, revision procedures, and patients lost to follow-up were excluded. Patients were classified according to the presence or absence of a first metatarsal fracture, and logistic regression analysis was conducted to determine the associated risk factors.

Results: First metatarsal fractures occurred in 5.4% (27 of 499 feet), with type II fractures being most common (40.7%). On multivariable logistic regression, both older age and simultaneous bilateral surgery were independently associated with fracture. The odds of fracture increased by 8.6% per year of age (OR 1.086 (95% CI 1.032 to 1.150); p = 0.003) and were higher in patients undergoing bilateral versus unilateral surgery (OR 4.02 (95% CI 1.75 to 9.80); p = 0.001). Bone mineral density of the femur and lumbar spine was not associated with fracture risk.

Conclusion: Advanced age and bilateral surgery are key predictive factors for first metatarsal fractures following minimally invasive HV correction. Tailoring surgical and postoperative strategies, especially in elderly patients, may help mitigate fracture risk. Further research should explore metatarsal-specific bone density, surgical biomechanics, and younger patient cohorts.
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NewsBot · Mar 16, 2026

Radiological and Functional Outcomes of Fourth-Generation MIS Hallux Valgus Correction (META) in an Indian Population
Pradeep Moonot, Nishant Jaiswal, Kunal Chaudhari, Lulu Damsas & Sagar Chaudhari
Indian Journal of Orthopaedics

Background

Over 150 variants of conventional open operative techniques have been described for primary correction of HV. MIS in the treatment of hallux valgus deformity has gained increasing popularity since the 1990s with the advantages of less soft tissue dissection, reduced surgical time, and a faster recovery time. The most recent fourth-generation MIS hallux valgus is known as META (metaphyseal extra-articular transverse and Akin) having an additional benefit of correction of the rotational pronation deformity. This article describes the outcome of META in an Indian population.
Methodology

50 feet were operated using fourth-generation MIS (META) for HV correction and assessed based on their functional (AOFAS-Hallux and VAS) and radiological (HVA, IMA, and DMMA) parameters at 6 months post-surgery.
Results

At 6 months, AOFAS-hallux score significantly improved from 62.1 ± 12.34 to 94.56 ± 5.58 post-operatively, VAS decreased conspicuously from 5.78 ± 2.35 to 1.22 ± 1.03, HVA decreased from 29.4 ± 7.36 to 6.1 ± 5.24, and IMA improved from 15.76 ± 1.6 to 5.12 ± 2.49. DMMA declined from 16.36 ± 4.30 to 5.23 ± 5.75. P values of all the variables suggested high significance.
Conclusion

This is the first and the largest case series to be published regarding the outcome of fourth-generation MIS hallux valgus correction (META) in India. META helps in decreasing the chances of recurrence. Although it has a steeper learning curve, but it has the advantages of lesser operative time, minimal blood loss, better cosmesis, lower chances of infection, lesser pain, and quicker rehabilitation of the patient. Complications can be prevented and their incidence can be minimized with practice.
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NewsBot · Mar 17, 2026

Outcomes of minimally invasive versus open hallux valgus surgical correction: A systematic review and fragility analysis
Samuel R. Zverev, et al
Source

Comparative trials evaluating surgical outcomes are critical in guiding treatment for hallux valgus. However, the statistical stability of these outcomes is not well documented.
Purpose The purpose of this study was to evaluate the statistical fragility of comparative studies analyzing minimally invasive surgery (MIS) versus open techniques for hallux valgus correction.
Study
Design A systematic review identified comparative studies assessing MIS versus open hallux valgus correction.
Methods
Outcome data were extracted with Fragility Index (FI) and Continuous Fragility Index (CFI) calculated for significant outcomes, and reverse FI (rFI) and reverse CFI (rCFI) for nonsignificant outcomes. Fragility Quotient (FQ) was calculated for each and compared to the number of patients lost to follow-up (LTFU).
Results
Of 628 studies screened, 18 met inclusion criteria, totaling 1,369 patients. Among 88 dichotomous outcomes, the median FI was 2, FQ was 0.021, rFI was 4, and rFQ was 0.072. For 236 continuous outcomes, the median CFI was 8, CFQ was 0.116, rCFI was 19, and rCFQ was 0.280.
Conclusion
This is the first study to evaluate fragility in comparative trials on MIS versus open hallux valgus correction and among the first to assess reverse fragility in continuous outcomes. Significant results were more fragile than nonsignificant data and dichotomous outcomes were more fragile than continuous ones with nearly a quarter having an FI lower than the number of patients LTFU. Both outcome types demonstrated considerable statistical fragility supporting the cautious interpretation of MIS vs open hallux valgus findings and the reporting of statistical fragility data alongside P-values to better contextualize the robustness of clinical research.
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NewsBot · Mar 27, 2026

Time to Callus Formation With Minimally Invasive Bunion Surgery: Association of Intramedullary Plate Fixation With Earlier Consolidation Compared to Screw Fixation Techniques
Hon Keng Pui Bryan et al
Foot Ankle Orthop. 2026 Mar 15;11(1):24730114261427472.

Background: Hallux valgus (HV) remains a common forefoot deformity with a global prevalence of 19%. It is largely agreed that surgical correction of HV with minimally invasive techniques have good outcomes. Options include the percutaneous minimally invasive screw fixation (SF) and the intramedullary plate fixation (IPF) technique, with both employing different fixation techniques and hence stability of fixation. In this article, we aim to compare these 2 minimally invasive correction techniques and analyze the radiologic and clinical outcomes, including their time to consolidation.

Methods: A retrospective study was conducted using data from a single tertiary hospital involving 89 feet who underwent SF (n = 42) and IPF (n = 47) procedures. Radiologic grading of callus formation was determined based on 2 components, the visualization of callus formation and the obliteration of the fracture line. Sequential radiographs were evaluated postoperatively across a 6-month period looking for callus formation.

Results: A Fisher exact test was performed to examine the relation between both surgical procedures and the grade of callus formation. At 6 months, full callus formation was seen in both methods. However, at 3 months, there was a statistically significant difference between the 2 methods (P ≤ .05). IPF showed higher grades of callus formation than those in the SF group. In comparing the 2 groups, IPF also showed higher rates of full callus formation than those of the SF group (P ≤ .05).

Conclusion: IPF of HV appears to be associated with faster callus formation at 3 months postoperatively than SF, with a greater proportion showing full callus formation.
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NewsBot · Apr 6, 2026

Recurrence and Function After Minimally Invasive Hallux Valgus Correction: A Dual-Centre Retrospective Comparative Cohort Study of MICA Alone vs MICA+DMMO
Gil Genuth et al
Source

Background:
Hallux valgus (HV) is a common forefoot deformity associated with pain, gait impairment, and reduced quality of life. Minimally invasive chevron-Akin (MICA) osteotomy provides reliable correction with low reported recurrence. However, when combined with distal minimally invasive metatarsal osteotomies (DMMOs) for coexistent metatarsalgia, altered forefoot biomechanics may increase recurrence risk. No prior study has directly compared outcomes between isolated MICA and combined MICA+DMMO. The primary objective was to compare radiographic recurrence at 12 months, with secondary objectives including patient-reported outcomes, pain, and complications. We hypothesized that MICA+DMMO would be associated with higher radiographic recurrence.
Methods:
This retrospective comparative cohort study included 121 consecutive patients undergoing minimally invasive HV correction at 2 high-volume centres between 2019 and 2024, with a minimum 12-month follow-up. Sixty patients underwent MICA alone and 61 underwent MICA+DMMO (second-fourth metatarsals). Outcomes included radiographic angles (hallux valgus angle [HVA], intermetatarsal angle), Patient-Reported Outcomes Measurement Information System [PROMIS] physical function and pain interference, visual analogue scale (VAS) pain, and complications. Recurrence was defined as HVA >20 degrees.
Results:
Baseline demographics and deformity severity were comparable between groups. Both cohorts achieved significant early correction. At 12 months, mean HVA was lower following MICA alone (14.9 ± 3.8 degrees) compared with MICA+DMMO (17.7 ± 4.7 degrees; mean difference 2.8 degrees, 95% CI 1.0-4.6; P = .003). Radiographic recurrence occurred in 11.7% of MICA patients vs 47.5% of MICA+DMMO patients (absolute risk difference 35.8%, 95% CI 20.6-50.9; P < .0001). PROMIS physical function improved substantially in both groups, with greater 12-month improvement in the MICA+DMMO cohort (mean change 36.6 vs 29.8 points; mean difference 6.8, 95% CI 4.1-9.5; P < .0001), exceeding minimal clinically important difference thresholds. PROMIS pain interference decreased by more than 30 points in both groups, with no between-group difference. VAS pain improved similarly to a mean of 1.4 at final follow-up. Overall complication rates were comparable (15%).
Conclusion:
Both isolated MICA and combined MICA+DMMO were associated with radiographic correction and clinically significant improvements in pain and function at 12 months. However, the addition of DMMO is associated with a substantially higher rate of radiographic recurrence at 12 months despite greater functional gains; these findings should be interpreted as short-term observational associations rather than causal evidence. Further prospective studies are warranted to clarify the long-term biomechanical impact of combined procedures.
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NewsBot · Apr 11, 2026

Gender Differences in Early Recovery After Minimally
Invasive Distal Transverse Metatarsal Osteotomy - Akin
Osteotomy (MITA) for Hallux Valgus: A Propensity-Matched
Study of 300 Cases
Taebyeong Kang et al
Source

Background
Evidence regarding sex-based differences in outcomes after minimally invasive distal transverse metatarsal osteotomy
- Akin osteotomy (MITA) for hallux valgus remains limited. This study compared clinical and radiographic outcomes and
complication rates between male and female feet using a propensity score–matched cohort.
Methods
This retrospective study included 300 feet (150 male and 150 female) that underwent MITA. Male and female feet were
matched using propensity scores based on age, preoperative hallux valgus angle (HVA), and preoperative
intermetatarsal angle (IMA). Clinical outcomes were assessed using the visual analogue scale (VAS), American
Orthopaedic Foot and Ankle Society (AOFAS) score, and Manchester–Oxford Foot Questionnaire (MOXFQ).
Radiographic outcomes included HVA, IMA, and bony foot width. Assessments were performed preoperatively, at 3
months postoperatively, and at 1 year.
Results
After propensity matching, baseline age (53.6 vs 53.8 years), HVA (31.2° vs 31.1°), and IMA (14.2° vs 14.2°) were
comparable between groups. Preoperatively, male feet showed worse clinical status, with lower AOFAS scores (66.6 ±
13.5 vs 69.7 ± 10.7; p = 0.03), despite similar radiographic deformity. At 3 months postoperatively, male feet showed
better early clinical outcomes, including lower VAS pain scores (0.2 ± 0.4 vs 0.5 ± 0.8; p < 0.001), higher AOFAS scores
(91.2 ± 2.0 vs 90.3 ± 3.0; p = 0.002), and lower MOXFQ pain scores (12.0 ± 6.0 vs 16.0 ± 10.1; p < 0.001). At 1 year, clinical
outcomes were comparable between groups. Radiographic correction of HVA and IMA was similar between groups at
both 3 months and 1 year. Complication rates were low and comparable between groups.
Conclusions
Male feet undergoing MITA present with worse baseline functional impairment but show greater early postoperative
improvement, with clinical and radiographic outcomes comparable to those of female feet at 1 year. These ndings
suggest that sex inuences early recovery trajectory but not 1-year effectiveness of MITA
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NewsBot · Apr 22, 2026

Risk factors for metatarsal fracture in minimally invasive hallux valgus surgery: A case-control study
Gabriel Ferraz et al
Source

Introduction: Minimally invasive hallux valgus (HV) correction techniques, including percutaneous Chevron-Akin (PECA) and metaphyseal extra-articular transverse and Akin (META) osteotomies, offer favorable outcomes but are associated with unpredictable metatarsal fractures. This study identifies predictive factors for first metatarsal fractures following minimally invasive HV surgery. Methods: This retrospective case-control study analyzed 370 patients (499 feet) who underwent minimally invasive HV correction between November 2017 and August 2024 at a tertiary orthopedic center. Cases from the learning curve, revision procedures, and patients lost to follow-up were excluded. Patients were classified by the presence or absence of a first metatarsal fracture, and logistic regression was conducted to identify associated risk factors. Results: First metatarsal fractures occurred in 5.4% (27/499 feet), with Type II fractures being most common (40.7%). On multivariable logistic regression, both older age and simultaneous bilateral surgery were independently associated with fracture. The odds of fracture increased by 8.6% per year of age (OR 1.086, 95% CI 1.032-1.150, p = 0.003) and were higher in patients undergoing bilateral vs unilateral surgery (OR 4.02, 95% CI 1.75-9.80, p = 0.001). Bone mineral density (BMD) of the femur and lumbar spine was not associated with fracture risk. Conclusion: Advanced age and bilateral surgery are key predictive factors for metatarsal fractures following minimally invasive hallux valgus correction. Tailoring surgical and postoperative strategies, especially in elderly patients, may help mitigate fracture risk. Further research should explore metatarsal-specific bone density, surgical biomechanics, and younger patient cohorts.
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NewsBot · Apr 26, 2026

Bunionectomy inside-out: Intracortical medial exostectomy during minimally invasive hallux valgus correction
Thales Augusto et al
Source

In this technical report, we describe an intracortical “inside-out” technique for percutaneous medial exostectomy performed as a final step during modern minimally invasive hallux valgus correction. Contemporary third-generation minimally invasive Chevron-Akin (MICA/PECA) and fourth-generation metaphyseal extra-articular transverse constructs (META) provide powerful multiplanar correction with rigid fixation. However, residual medial bony prominence following distal fragment translation may persist and contribute to postoperative medial irritation. Traditional percutaneous exostectomy is commonly performed in an outside-in fashion and may increase the risk of capsular trauma or inadvertent articular injury when performed close to the first metatarsophalangeal (MTP) joint. Our technique uses the same 2.0-2.2 mm Shannon burr employed for the metatarsal osteotomy, introduced intraosseously through a minimal cortical entry. The medial prominence is progressively resected from cancellous bone toward the medial cortex under fluoroscopic and tactile guidance, while maintaining an outward safety vector away from the articular surface. We hypothesize that this approach provides a reproducible method to contour residual medial prominence while preserving medial capsuloligamentous structures.
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NewsBot · May 10, 2026

Comparison of Outcomes after Minimally Invasive Transverse Distal Metatarsal Osteotomy (MITO) and Proximal Phalangeal Osteotomy for Hallux Valgus With and Without Rheumatoid Arthritis: A Matched Cohort Study
Yeo Kwon Yoon et al
Source

Background:
There is an increasing role for joint-preserving surgery in hallux valgus (HV) management among patients with rheumatoid arthritis (RA). We compared radiologic and clinical outcomes after minimally invasive transverse distal metatarsal osteotomy (MITO) and a complete proximal phalangeal osteotomy for HV correction in patients with and without RA.
Methods:
This retrospective cohort study included 16 RA patients (21 feet) who underwent MITO between July 2018 and June 2023 with a minimum follow-up of 24 months. In total, 53 non-RA patients (63 feet) were matched by propensity score matching (1:3 ratio) after consideration of age, sex, body mass index, follow-up duration, preoperative hallux valgus angle (HVA), first-second intermetatarsal angle (1-2 IMA), and tibial sesamoid position (TSP). Radiologic evaluation included HVA, 1-2 IMA, and TSP measurements. Clinical outcomes were assessed using visual analog scale (VAS) pain scores, Foot and Ankle Outcome Scores, and Medical Outcomes Study Short Form Health Survey-36 physical component summary scores.
Results:
The matched cohorts consisted entirely of female patients, with a mean age of 63.7 years in the RA group and 63.3 years in the non-RA group. The mean follow-up duration was 38.1 months (range, 24-85 months). All radiologic parameters significantly improved at the last follow-up (all P < .001). Postoperative mean HVA, 1-2 IMA, and TSP were 4.9°, 3.9°, and 3, respectively, in the RA group and 7.0°, 5.2°, and 3, respectively, in the non-RA group; with the numbers available, no significant difference could be detected. Similarly, no significant difference could be detected in the final functional scores, and VAS met the predefined noninferiority margin. Likewise, no significant difference could be detected in total complications (P = 1.000) or reoperation rates (P = .184).
Conclusion:
MITO combined with a complete proximal phalangeal osteotomy yielded favorable radiographic improvements and noninferior pain relief in RA patients compared with non-RA patients. Our findings indicate that MITO with proximal phalangeal osteotomy may be a safe and effective minimally invasive joint-preserving surgical option for HV correction in RA patients without advanced first metatarsophalangeal joint destruction.
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NewsBot · May 20, 2026

Increased Risk of Recurrence in Severe
Hallux Valgus Associated With Inability
to Passively Correct Deformity Prior
to Surgery: A Comparative Study of
Transverse vs Chevron Osteotomy
Minimally Invasive Surgery Techniques
Thomas L. Lewis et al
Source

Background: The optimal osteotomy technique for severe hallux valgus deformity using minimally invasive surgery
remains unknown. This study aimed to explore the clinical and radiographic outcomes between chevron and transverse
osteotomies in patients with severe hallux valgus deformity
Methods: A retrospective cohort study was conducted including 131 feet (109 patients) with complete radiographic
follow-up who underwent hallux valgus correction using either percutaneous chevron and Akin osteotomy (PECA)
(n = 43 patients, 50 feet) or metaphyseal extra-articular transverse and Akin osteotomy (META) (n = 66 patients, 81 feet)
techniques. Radiographic parameters including hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured
at baseline, 6 weeks, and final follow-up. Patient-reported outcome measures were assessed using the Manchester-
Oxford Foot Questionnaire (MOXFQ), visual analog scale (VAS) for pain, and EuroQol 5 dimension–5 level questionnaire.
Recurrence was defined as a final HVA exceeding 20°. Complication rates and passive correctability were also analyzed.
Results: Baseline characteristics were similar between groups, except for significantly higher initial IMA in the PECA
group (17.8° vs 15.8°, P = .001). Both techniques achieved significant deformity correction. At final follow-up, the PECA
group demonstrated a significantly lower HVA compared to the META group (11.7° vs 14.5°, P = .045), whereas final IMA
measurements were similar (5.2° vs 4.9°, P = .642). Recurrence rates were significantly lower in the PECA group (10.0% [95%
CI: 4.3%–21.4%] vs 27.2% [95% CI: 18.7%–37.7%], P = .025). Pre-operative passive correctability was significantly higher in
the PECA group (68.0% vs 46.9%, P = .020), particularly amongst recurrent cases (80.0% vs 27.3%, P = .047). No significant
differences were observed in MOXFQ scores between groups, although VAS pain favored the META group (6.2 [SD 12.3]
vs 11.9 [SD 17.5], P = .046). Complication rates were comparable (PECA: 13.2% vs META: 8.6%, P = .40). Complication rates
were comparable (PECA: 13.2% vs META: 8.6%, P = .40), with different complication profiles noted between techniques.
Conclusion: Both PECA and META techniques provide effective correction of hallux valgus deformity. The higher
recurrence rate observed in the META group was associated with a significantly lower rate of pre-operative passive
correctability in that cohort.
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NewsBot · May 29, 2026

Does First Metatarsal Head Lowering During Minimally Invasive Chevron Akin Osteotomy Yield No Significant Difference in Patient-reported Outcomes Compared With Second Distal Metatarsal Minimally Invasive Osteotomy for Treating Intractable Plantar Keratosis?
Jun Young Choi et al
Clin Orthop Relat Res. 2026 Jun 1;484(6):1133-1148.

Background: Hallux valgus is a common forefoot deformity that alters forefoot loading and often leads to secondary complications such as intractable plantar keratosis beneath the second metatarsal head. Although the link between hallux valgus and intractable plantar keratosis is recognized, whether two procedures that correct intractable plantar keratosis through different mechanisms-minimally invasive chevron Akin osteotomy (MICA) with first metatarsal head lowering and conventional MICA combined with second distal metatarsal minimally invasive osteotomy (DMMO)-have differential effects on symptom improvement has not, to our knowledge, been assessed.

Questions/purposes: (1) Do patients with hallux valgus and intractable plantar keratosis beneath the second metatarsal head have distinctive radiographic features compared with those with hallux valgus alone? (2) How do the two different surgical strategies (MICA with first metatarsal head lowering versus MICA with second DMMO) differ in terms of lesser metatarsal head height and intractable plantar keratosis resolution? (3) What are the differences in the Foot and Ankle Ability Measure (FAAM), including the subscales for activities of daily living (ADL) and sports, and other complications between these techniques?

Methods: Between January 2017 and June 2024, two surgeons treated 194 feet with hallux valgus using MICA after predefined exclusions. Of these, 113 feet did not have preoperative intractable plantar keratosis beneath the second metatarsal head; after excluding 13 feet without a minimum 1-year follow-up, 100 feet were included as a reference cohort. The remaining 81 feet had preoperative intractable plantar keratosis beneath the second metatarsal head and constituted the primary study cohort. Within this group, 34 feet underwent MICA with first metatarsal head lowering and 47 feet underwent MICA with second DMMO. From 2017 to 2020, MICA with second DMMO was routinely used for patients with intractable plantar keratosis beneath the second metatarsal head. Beginning in 2021, we gradually incorporated first metatarsal head lowering, and both procedures were used thereafter based on first-ray sagittal alignment, intraoperative loading patterns, and patient preference. After excluding feet without a minimum 1-year follow-up, 30 feet in the MICA with first metatarsal head lowering group and 42 feet in the MICA with second DMMO group were available for comparative analysis. There was no differential loss to follow-up between study groups for analysis in this retrospective study (12% [4 of 34] and 11% [5 of 47]). Follow-up completeness was comparable between groups, with similar mean ± SD follow-up durations (15 ± 3 months versus 17 ± 4 months). The study population had a mean age of 57 years and was predominantly female (approximately 90%), with comparable demographic characteristics between groups. To answer our first study question, we compared preoperative radiographic characteristics-including hallux valgus angle, first-to-second intermetatarsal angle, and the relative length and height of the lesser metatarsals-between patients with and without intractable plantar keratosis beneath the second metatarsal head. To address our second study question, we evaluated the changes in the relative height of the lesser metatarsals and postoperative resolution of intractable plantar keratosis following two different techniques. To answer our third study question, we compared the FAAM-ADL and sports scores and procedure-related complications between the two surgical techniques. All p values were adjusted using the Holm-Bonferroni method. Because some patients contributed bilateral feet, analyses were adjusted for the nonindependence of observations using a mixed-effects model with patient as a random effect; within-patient correlation was negligible, supporting inclusion of both feet in the analysis.

Results: Patients with hallux valgus and intractable plantar keratosis beneath the second metatarsal head had a larger hallux valgus angle (mean ± SD 35° ± 8° versus 31° ± 8°, mean difference 4° [95% confidence interval (CI) 1° to 5°]; p < 0.001) and lower second (3 ± 2 mm versus 1 ± 2 mm, mean difference 2 mm [95% CI 1.5 to 2.7]; p < 0.001) and third metatarsal heads (4 ± 2 mm versus 2 ± 1 mm, mean difference 2 mm [95% CI 1.3 to 2.5]; p < 0.001) than those without intractable plantar keratosis. Both procedures resolved intractable plantar keratosis at similar percentages (87% [26 of 30] versus 91% [38 of 42], OR 0.7 [95% CI 0.2 to 3.0]; p = 0.71). However, MICA with first metatarsal head lowering elevated both the second (-2 mm [95% CI -4.2 to 0]) and third metatarsal heads (-2 mm [95% CI -3.8 to 0]), whereas MICA with second DMMO elevated the second (-2 mm [95% CI -4.7 to -0.1]) but lowered the third (1 mm [95% CI -0.4 to 2.4]), producing a between-group difference of 3 mm (95% CI 1.9 to 3.9; p < 0.001). Functional outcomes improved in both groups, but MICA with first metatarsal head lowering showed greater improvement in FAAM-sports scores (24% versus 21%, mean difference 3% [95% CI 2% to 7%]; p = 0.04). Postoperatively, MICA with second DMMO resulted in new intractable plantar keratosis beneath the third metatarsal head (10% [4 of 42]). In contrast, first metatarsal head lowering more frequently caused plantar discomfort beneath the first metatarsal head (17% [5 of 30]).

Conclusion: Accurate assessment of metatarsal height in the axial plane is essential when surgically treating hallux valgus with intractable plantar keratosis. Although both adjunctive procedures-first metatarsal head lowering and second DMMO-effectively improved intractable plantar keratosis, they differ in their corrective mechanisms and associated risks: adding only second DMMO may predispose patients to new keratosis beneath the third metatarsal head, whereas lowering the first metatarsal head may result in postoperative plantar discomfort beneath the first metatarsal head.
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NewsBot · Jun 6, 2026

The Effect of Minimally Invasive Hallux Valgus Surgery on Surgeon Case Volumes in a Single Institution: An Observational Retrospective Trend Analysis
Levi Smith DPM et al
Foot & Ankle Surgery: Techniques, Reports & Cases 27 May 2026, 100645

The effects of the introduction of minimally invasive surgical techniques have been reported in many fields of surgery and subspecialties, including urology, general surgery, surgical oncology, and gynecology; however, the effect that introducing minimally invasive hallux valgus surgery into an institution has on surgical volumes is unknown. In 2019, a single podiatric surgeon in our institution began using a minimally invasive surgical approach to bunion correction, while colleagues continued using an open approach, which afforded the opportunity to compare over time not only trends in minimally invasive versus open surgical volumes, but also those in surgical volumes of the surgeon using a minimally invasive approach with those of colleagues using an open approach. We therefore conducted a retrospective observational trend analysis evaluating 919 hallux valgus surgeries performed by 8 podiatric surgeons from 01/2015 through 12/2024. The surgeon who employed a minimally invasive correction technique had a statistically significant increase in rate of hallux valgus surgeries performed, while surgeons using an open approach overall had a decrease in rate of hallux valgus surgeries performed over the time period. During the study period, the volume of minimally invasive hallux valgus surgeries performed over time also increased. Future investigations are warranted to determine whether these trends can be applied to other types of foot and ankle surgery and to better understand what implications this suggests for shaping foot and ankle surgeon education/training, predicting healthcare costs related to these procedures, and ultimately providing superior patient outcomes.
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NewsBot · Jun 17, 2026

Minimally Invasive Osteotomy with Intramedullary Plating for the Correction of Hallux Abducto Valgus: A Multicenter Retrospective Radiographic Review
Benjamin Wehrli et al
Source

Background
Minimally invasive bunion surgery continues to be a rapidly growing area of interest and growth, relative to a traditional approach with numerous approaches and techniques that seek to accomplish similar goals of deformity correction, aiming for superior outcomes but with added efficiency. Various techniques describe implementing the use of a wire, single or dual screw fixation, with a distinct approach utilizing an intramedullary plating technique.
Purpose
The primary objectives of this study were to examine the outcomes of minimally invasive bunion surgery with intramedullary plating in the setting of the surgical management of hallux abducto valgus, focusing on radiographic parameters related to and commonly measured in this deformity. The secondary objectives of this study were to report on various abnormal radiographic parameters
Study Design
Retrospective Cohort Review
Methods
The radiographs from 341 patients (346 feet) who underwent minimally invasive distal metatarsal osteotomy with application of an intramedullary plating technique system from August 1, 2016 to May 31, 2025 at participating centers were retrospectively evaluated. Patients in the study were assessed for pre- and post-operative radiographic parameters with a primary focus on intermetatarsal angle, hallux abductus angle and tibial sesamoid position.
Results
A significant reduction in intermetatarsal angle (IMA), hallux abductus angle (HAA), and tibial sesamoid position (TSP) (Preoperative IMA:13.4 ° ± 4.6 ° (range 2.1 ° – 37.7 °), final postoperative IMA:1.5 ° ± 2.4 ° (range -5.0 ° - 13.2 °); Preoperative HAA: 23.7 ° ± 11.1 ° (range 1.0 ° - 58.0 °), final postoperative HAA: 5.9 ° ± 5.0 ° (range 0.1 ° - 31.2 °). Preoperative TSP: 4.8 ± 1.6 (range 1 - 7), final postoperative TSP: 1.4 ± 0.9 (range 1 - 7). Overall correction was found to be 88.7 %, 75.2 %, and 70.8 % in these groups, respectively; p < 0.001 to all groups) was found.
Conclusion
The use of an intramedullary plate in a minimally invasive approach to address a spectrum of hallux valgus deformity showed promising, reproducible results across a multicenter setting for the reduction and prolonged correction when assessing radiographic outcomes without significant complications.
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NewsBot · Jul 23, 2026

Weightbearing CT Evaluation of Contact and Distance Mapping of the First Tarsometatarsal and Metatarsophalangeal Joints Following MIS Hallux Valgus Correction
Sudheer C Reddy et al
Foot Ankle Spec. 2026 Jul 22:19386400261465100.

BackgroundThree-dimensional distance and coverage mapping (DM and CM) generated through weightbearing CT (WBCT) can aid in understanding the complex articular relationship in hallux valgus (HV). Minimally invasive (MIS) hallux valgus correction has become popular in correcting this deformity. Prior biomechanical studies have demonstrated that alterations occur at the first metatarsophalangeal (MTP) and tarsometatarsal (TMT) articulations following correction. The purpose of this study is to evaluate DM and CM characteristics at the first MTP and TMT joint as well as the medial metatarsosesamoid joint in a cohort of hallux valgus patients following MIS hallux valgus correction.MethodsTwelve patients (10 female, 2 male; mean age 56.42 ± 13.15 years) were enrolled, undergoing preoperative and 6-month postoperative WBCT scans following MIS hallux valgus correction. Foot Ankle Ability Measure (FAAM) scores were also collected at both visits. Automated segmentation was performed using a deep learning-based approach to generate accurate bone masks from volumetric imaging data. Coverage (contact) and distance maps were created based on established protocols for the medial metatarsosesamoid, first MTP, and first TMT joints. Statistical analysis was conducted using paired t-tests and Wilcoxon signed-rank test as appropriate.ResultsRegarding distance maps, at the metatarsosesamoid articulation, there was a significant increase in distance between the metatarsal and medial sesamoid along all quadrants of the joint postoperatively when compared with preoperative (P < .05). At the MTP and TMT joints, there was no significant change in joint distance postoperatively. Regarding coverage maps, at the MTP joint, increases in joint contact for dorsomedial (17.9 ± 11.1% vs 38.5 ± 15.1%, P < .001) and plantarmedial (21.7 ± 16.0% vs 54.1 ± 24.7%, P < .001) quadrants when compared with pre-op were observed. There was no significant change along its dorsolateral (80.3 ± 10.1% vs 68.7 ± 16.2%, P = .05) or plantarlateral (87.5 ± 6.5% vs 86.8 ± 10.6% P = .85) aspects. At the TMT joint, there was a significant increase at the dorsolateral (83.5 ± 11.8% vs 89.7 ± 10.2%, P = .02) and plantarlateral (57.6 ± 4.7% vs 65.4 ± 5.6%, P < .001) quadrants when compared with pre-op. There was a significant decrease in contact along the dorsomedial (89.2 ± 13.1% vs 71.1 ± 20.6%, P = .002) and plantarmedial (86.7 ± 10.6% vs 70.2 ± 14.3%, P < .001) quadrants. There was no difference between pre-op and post-op FAAM scores.DiscussionNotable differences were observed with respect to contact maps at the MTP and TMT joints indicating improved coverage of the MTP joint postoperatively. Relative decrease in coverage was observed at the medial TMT joint, reflecting medial displacement of the proximal metatarsal segment. Distance mapping at the medial metatarsosesamoid articulation demonstrated improved sesamoid alignment postoperatively.
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NewsBot · Jul 27, 2026

Impact of First Metatarsal Capital Fragment Translation on Complication and Osseous Healing After Minimally Invasive Bunionectomy
Christian P. Frey et al
Source

Background
Minimally invasive bunion surgery relies on controlled lateral translation of the first metatarsal capital fragment, but the relationship between translation magnitude and postoperative outcomes remains unclear.
Purpose
To evaluate the association between percentage lateral translation of the first metatarsal capital fragment and postoperative complications following minimally invasive bunionectomy. Secondary aims included radiographic union, first metatarsal regeneration patterns, and preoperative deformity severity.
Study design
Retrospective cohort study.
Methods
Sixty-two consecutive minimally invasive bunionectomy procedures performed in 53 patients were retrospectively reviewed. Mean follow-up was 9.3 ± 7.6 months. Outcomes included hardware-related complications, wound complications, revision surgery, radiographic union, and metatarsal regeneration patterns. Translation was analyzed as a continuous variable and by a threshold of ≥100% versus <100% of metatarsal shaft width.
Results
Hardware-related complications occurred in 26% (16/62) of procedures. Translation ≥100% was associated with a higher complication rate than <100% translation (3/5 [60%] vs 13/57 [23%]; OR 4.61, p = 0.080). No statistically significant association was identified between translation percentage and complications across the cohort. Radiographic union occurred in 94% (58/62) of cases and was not influenced by translation magnitude. Increasing translation was not significantly associated with first metatarsal regeneration type nor was preoperative deformity severity associated with complication risk.
Conclusion
Complete loss of cortical apposition, ≥100% translation, was associated with higher observed hardware-related complication rates, although this finding did not reach statistical significance and was based on a small subgroup (n = 5). These results warrant further investigation in larger studies to define safe limits of capital fragment translation.
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NewsBot · Aug 6, 2026

Radiological and Functional Outcomes of Fourth-Generation MIS Hallux Valgus Correction (META) in an Indian Population
Pradeep Moonot et al
Indian J Orthop. 2026 Mar 6;60(8):2054-2060.

Background: Over 150 variants of conventional open operative techniques have been described for primary correction of HV. MIS in the treatment of hallux valgus deformity has gained increasing popularity since the 1990s with the advantages of less soft tissue dissection, reduced surgical time, and a faster recovery time. The most recent fourth-generation MIS hallux valgus is known as META (metaphyseal extra-articular transverse and Akin) having an additional benefit of correction of the rotational pronation deformity. This article describes the outcome of META in an Indian population.

Methodology: 50 feet were operated using fourth-generation MIS (META) for HV correction and assessed based on their functional (AOFAS-Hallux and VAS) and radiological (HVA, IMA, and DMMA) parameters at 6 months post-surgery.

Results: At 6 months, AOFAS-hallux score significantly improved from 62.1 ± 12.34 to 94.56 ± 5.58 post-operatively, VAS decreased conspicuously from 5.78 ± 2.35 to 1.22 ± 1.03, HVA decreased from 29.4 ± 7.36 to 6.1 ± 5.24, and IMA improved from 15.76 ± 1.6 to 5.12 ± 2.49. DMMA declined from 16.36 ± 4.30 to 5.23 ± 5.75. P values of all the variables suggested high significance.

Conclusion: This is the first and the largest case series to be published regarding the outcome of fourth-generation MIS hallux valgus correction (META) in India. META helps in decreasing the chances of recurrence. Although it has a steeper learning curve, but it has the advantages of lesser operative time, minimal blood loss, better cosmesis, lower chances of infection, lesser pain, and quicker rehabilitation of the patient. Complications can be prevented and their incidence can be minimized with practice.
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NewsBot · Sep 7, 2026 at 10:04 PM

First tarsometatarsal joint medial subluxation after contemporary minimally invasive distal osteotomy for hallux valgus: A weight-bearing computed tomography assessment
Joaquin Palma et al
Foot Ankle Surg. 2026 Aug 19:S1268-7731(26)00221-3.

Background: Minimally invasive (MIS) osteotomy for Hallux Valgus (HV) may alter the congruence of the first tarsometatarsal joint (1ST-TMT). This study evaluated postoperative 1ST-TMT subluxation and associated imaging factors.

Methods: This retrospective cohort included 63 patients undergoing MIS HV correction with ≥ 6 months of radiological follow-up. Imaging parameters included a novel C1 - M1 joint lateral distance to assess 1ST-TMT subluxation. Multivariable linear regression evaluated factors associated with postoperative subluxation and midshaft foot width.

Results: Interobserver reliability for the C1 - M1 joint lateral distance was excellent (r = 0.93). Mean C1 - M1 lateral distance increased from 0.26 to 1.33 mm (P<0.001), with a greater dorsal displacement (2.6 mm). Postoperative subluxation correlated with preoperative C1 - M1 lateral distance (P=0.022) and plantar gap (P = 0.008) and was associated with increased midshaft foot width (P=0.004).

Conclusion: MIS HV correction was associated with consistent dorsal 1ST-TMT medial subluxation and increased midshaft foot width. Future studies are needed to determine the clinical relevance of these findings.
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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 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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