Outcome of Minimally Invasive Chevron and Akin Procedure With an Osteotomized Metatarsal Head Translation of More Than Fifty Percent for the Correction of Hallux Valgus

Abstract

Background: Surgical protocols for hallux valgus (HV) surgery rely on the severity of the deformity, utilizing various techniques for different severity grades. The purpose of this study was to evaluate the association between the extent of the distal fragment translation and patient-reported outcome measures (PROMs) in patients with HV of varying severity grades who had undergone the same surgery, a minimally invasive chevron and Akin (MICA) procedure, with a fragment translation of at least 50%.

Methods: We conducted a retrospective study of patients who had undergone a MICA procedure for HV between January 1, 2017, and August 1, 2022, and had had at least 1-year follow-up. We collected medical and demographic information and conducted radiographic measurements. PROMs (European Foot and Ankle Society questionnaire and satisfaction anchor questions) were the primary outcome measure and were collected via a telephone survey.

Results: Of the 140 cases reviewed, 105 (75% [97 patients]) were included: six (5.7%) were defined as mild HV, 66 (62.9%) as moderate HV, and 33 (31.4%) as severe HV. The mean preoperative and postoperative first intermetatarsal angles were 13.67 ± 2.94° and 3.1 ± 2.34°, respectively. The mean preoperative and postoperative HV angles were 31.41 ± 8.56° and 8.21 ± 5.02°, respectively. The mean translation was 77.49 ± 13.18%. The extent of translation did not correlate with intermetatarsal angle or HV angle (P = .45 and .62, respectively). The PROM questionnaires were answered by 73 patients (80 feet [76.19% of total cases]). The mean postoperative European Foot and Ankle Society score was 18.59 ± 6.63, and 67 patients (83.8%) declared that they were satisfied with the surgery. PROMs were not associated with preoperative HV severity or translation extent (P > .1).

Conclusions: With MICA distal osteotomy and translation of the first metatarsal head by more than 50% (up to 100%), we were able to correct even severe HV deformities that would previously have required proximal osteotomies and obtain significant angle correction with good clinical results.