Indication and Consideration of Minimally Invasive Bosh Akin (MIBA) for Salvage in Recurrence of Hallux Valgus

Abstract

Category: Bunion Introduction/Purpose: Hallux valgus recurrence is a common complication to consider, depending on the different series it has an incidence of between 5-15%, being one of the most frequent complications reported after surgical surgery, however, not all of them require surgical treatment. This has a multifactorial origin with factors depending on the surgeon, the chosen surgical technique and some components of the deformity not completely corrected during the initial surgery. In cases where this recurrence requires surgical correction, it is a challenge for both the patient and the surgical team, and the success of the treatment depends on correct identification of the cause of failure after primary surgery and correct surgical planning. We present some technical considerations for choosing a minimally invasive osteotomy in this cases. Methods: The inappropriate selection of the technique in a patient with a recurrence of hallux valgus has a high rate of failure. In this sense, we must carry out a precise preoperative evaluation of the patients, both clinical and radiological, using weight-bearing X-rays or even a Weight-bearing CT scan that allows Adequate planning to evaluate rotation and pronation of the metatarsal more reliably, associated with an evaluation of sesamoid subluxation, possible signs of cuneometatarsal instability, such as plantar gap, articular facet obliquity, cortical thickening of the 2nd metatarsal. This also allows us to confirm the presence of metatarsophalangeal arthrosis, or sesamoid metatarsal arthritis that could influence our decision algorithm. Results: Similar to a primary hallux valgus, an asymptomatic deformity should only be observed and if it becomes symptomatic or has a considerable rate of progression, it should be treated surgically. In cases of symptomatic deformities we should always consider the presence of metatarsophalangeal osteoarthritis, medial column instability, if these are not present as indicated by Raikin in his algorithm proposed in 2014, we consider an osteotomy as a revision procedure in a recurrent hallux. In this scenario, we have considered this alternative for selected cases, using the minimally invasive Bosh Akin (MIBA) technique, as a salvage alternative in surgery for recurrences of Hallux valgus. We present a series of 4 feet successfully treated with MIBA osteotomy Conclusion: The application of the miba osteotomy is an effective alternative for the treatment of recurrence of Hallux valgus, which achieves results similar to other open rescue techniques with less aggression of soft tissue