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Comparative Study
. 2025 Feb 20;20(1):185.
doi: 10.1186/s13018-025-05569-7.

Comparative analysis between Reverdin-Isham Osteotomy (RIO) and minimally invasive intramedullary nail device (MIIND) in association with AKIN osteotomy for Hallux valgus correction

Carlo Biz  1   2 , Nicola Luigi Bragazzi  3 , Anna Di Rita  1 , Assunta Pozzuoli  4   5   6 , Elisa Belluzzi  7   8   9 , Maria Grazia Rodà  1 , Pietro Ruggieri  1   2
Affiliations
Comparative Study

Comparative analysis between Reverdin-Isham Osteotomy (RIO) and minimally invasive intramedullary nail device (MIIND) in association with AKIN osteotomy for Hallux valgus correction

Carlo Biz et al. J Orthop Surg Res. .

Abstract

Background: Hallux valgus (HV) is a widespread condition that leads to discomfort in daily life. There are different surgical techniques for HV. This retrospective and comparative study aimed to compare the clinical and radiographic outcomes of the Reverdin-Isham osteotomy (RIO) and the Minimally Invasive Intramedullary Nail Device (MIIND) surgical techniques.

Methods: One hundred ninety-six patients with mild-to-severe HV were enrolled and divided into two groups: 98 patients with mild-moderate HV and 98 with moderate-severe HV, treated with the RIO and MIIND techniques, respectively. Radiographic and clinical evaluations were assessed preoperatively at 3, 12 and 60 months after surgery. Radiologically, the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and Tibial Sesamoid Position (TSP) were evaluated. Clinically, the AOFAS hallux metatarsophalangeal-interphalangeal scale and the Numeric Rating Scale (NRS-11) for pain were assessed. A propensity score matching (PSM) model was implemented to compare the two techniques.

Results: In the RIO group, the mean HVA correction from preoperative value to 60 months of follow-up was 8.69° (p < 0.0001), the mean IMA correction was 2.42° (p < 0.0001), and the mean DMAA correction was 0.09°. In the MIIND group, the mean HVA correction was 24.92° (p < 0.0001), the mean IMA correction was 8.75° (p < 0.0001), and the mean DMAA correction was 6.28° (p < 0.0001). The mean AOFAS score improved over time, and NRS-11 decreased in both groups. After PSM model application, the variables that impacted the allocation to RIO or MIIND techniques were age, preoperative HVA values and HV severity.

Conclusion: Our study demonstrates the efficacy of RIO for mild-moderate HV and MIIND for moderate-severe HV. Radiographic and clinical outcomes improved in both groups, but older patients with higher HVA and severe HV should be treated with the MIIND technique to achieve satisfactory outcomes.

Level of evidence: III, retrospective cohort study.

Keywords: Akin; Endolog; Hallux valgus; MIIND; RIO; Reverdin-Isham; Sesamoids.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Declaration of Helsinki and its later amendments, or comparable ethical standards. The Institutional Ethics Committee approved this study (CESC Code 4064/AO/17). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the PSM algorithm
Fig. 2
Fig. 2
ROC curve of the logistic regression model that has informed the PSM algorithm
Fig. 3
Fig. 3
Boxplots showing the result of the PSM
Fig. 4
Fig. 4
Flowchart of cohort selection
Fig. 5
Fig. 5
Case 1: A 69-year-old man having undergone the Reverdin-Isham and Akin osteotomies for moderate HV correction of his right foot. Weightbearing radiographic images of anteroposterior view at (A) preoperative period, (B) 1-month follow-up, (C) 3-month follow-up, (D) 12-month follow-up, and (E) last follow-up at 60 months after surgery, showing bone callus consolidation and remodeling, a stable and long-lasting radiographic correction
Fig. 6
Fig. 6
Case 2: A 58-year-old woman having undergone the Minimally Invasive Intramedullary Nail Device technique with Akin percutaneous osteotomy for severe HV correction of her right foot. Weightbearing radiographic images of anteroposterior view at (A) preoperative period, (B) 1-month follow-up, (C) 3-month follow-up, (D) 12-month follow-up, and (E) last follow-up at 60 months after surgery, showing bone callus consolidation and remodeling, a stable and long-lasting radiographic correction
Fig. 7
Fig. 7
Impact of each variable on the PSM algorithm
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