Akin Osteotomy Research Articles

Polyvinyl Alcohol Hydrogel Hemiarthroplasty of the First Metatarsophalangeal Joint Augmented With 3D-printed Baseplate

Hallux rigidus is the most common arthritic pathology of the foot and is a debilitating disease that causes pain, swelling, and reduced range of motion. Although arthrodesis is the gold standard treatment option, a soft hemiarthroplasty implant, the polyvinyl alcohol (PVA) hydrogel, has been designed to preserve motion in the first metatarsophalangeal joint and alleviate pain. Made from synthetic PVA and saline, the index noninferiority trial showed satisfactory clinical outcomes. However, this result was not reproducible by others with implant subsidence being a common concern. In this surgical technique, we describe a novel modified approach which involves PVA hemiarthroplasty of the first metatarsophalangeal joint, 3-dimensional-printed baseplate and Akin osteotomy to ultimately prevent likely implant failure.

Time to maximum clinical improvement following minimally invasive chevron and Akin osteotomies (MICA) in hallux valgus surgery

BackgroundThere is increasing evidence of positive improvement in clinical and radiological outcomes following minimally invasive hallux valgus deformity correction surgery (MIS). This study investigated the rate of improvement in clinical patient reported outcome measures (PROMs) following MIS as this is not well understood. MethodsBetween July 2014 and July 2019, data was prospectively collected from consecutive patients pre-operatively and at 6, 12, and 24 months following third-generation minimally invasive chevron and Akin osteotomies (MICA). Radiographic deformity and correction was assessed using weight-bearing radiographs pre-operatively and 6 weeks post-operatively. The primary outcome measure was the change in Manchester Oxford Foot Questionnaire (MOXFQ) score at each time point. Secondary outcomes include radiographic deformity correction, health-related quality of life PROMs and exploration of cases where PROMs did not improve. ResultsThere were 202 feet with complete PROM data for every time point. There was a statistically significant improvement in MOXFQ Index score at each time point (p < 0.05) following MICA surgery. The majority of the improvement occurred within the first 6 months. A subgroup of 17 feet (8.4%) were identified which had worse MOXFQ Index scores 6 months following MICA. For 14 feet in this subgroup (82.4%), the MOXFQ Index score subsequently improved over time such that by two years, their score had significantly improved compared to their pre-operative score. ConclusionThe majority of PROM improvement with MICA is gained by 6 months post-operatively but further significant improvement can be seen up to 2 years. Those patients who have not improved at 6 months, are likely to do so with time. Level of evidenceIV.

Radiographic Evaluation of Isolated Continuous Compression Staples for Akin Osteotomy Fixation

Category:Bunion; OtherIntroduction/Purpose:The use of continuous compression implants (nitinol staples) in orthopaedic surgery has increased secondary to advances in metal alloy engineering. Biomechanical studies provide useful data supporting the theoretical use of nitinol staples in the foot and ankle. However, clinical data is limited. The purpose of this study was to determine the overall effectiveness, both clinically and radiographically, of continuous compression implants (nitinol staples) to achieve bony healing in the medially based, closing-wedge osteotomy of the proximal phalanx of the great toe (Akin osteotomy).Methods:A retrospective chart review was performed on 104 patients (107 feet) who underwent an Akin osteotomy using nitinol staples between January 1st, 2018 and February 20th, 2020. The primary outcome variable was radiographic evidence of healing on x-ray. X-rays were independently reviewed by three board-certified foot and ankle surgeons. All investigators were blinded towards the x-rays, and x-rays were randomized in terms of timing from surgery. Each investigator reviewed digital radiographs independently and recorded their radiographic finding responses. Osteotomies were deemed healed if greater than 50% of the osteotomy contained bridging bone. A partially healed osteotomy was defined as some bridging bone, but less than 50% of the overall osteotomy site, and a nonunion was defined as no healing seen radiographically, broken hardware, or loss of reduction.Results:Radiographic union (partial or full) was seen in 95% of Akin osteotomies (96/101) based on our parameters, with no loss of initial reduction. Only 2.8% (3/107) of the patient population had unplanned return to the operating room for reasons associated with the Akin osteotomy: one infection (0.9%), one irritable hardware removal (0.9%), and one traumatic disruption of fixation (0.9%). None of the eligible staples (0/106) were found to be fractured upon radiographic analysis. Smokers and diabetics represented 4.8 and 8.7 percent of the patient population, respectively.Conclusion:Since its inception in 1925, the Akin osteotomy has been described using several types of fixation methods. The results of this retrospective study show that continuous compression implants (nitinol staples) are a viable option for Akin osteotomy fixation, with low rates of complications (2.8%, 3/107) and high healing rates (95%, 96/101). Staples are lower profile, eliminating hardware irritation and potential secondary surgeries, are technically less demanding, and time of application is decreased when compared to other fixation methods. They offer the benefit of continuous compression of the fusion site, as well, and are rigid enough to maintain reduction.

When it is necessary to perform an additional akin osteotomy with a scarf osteotomy for mild and moderate deformities of hallux valgus?

SummaryIntroduction. Scarf osteotomy is a common method of treating acquired hallux valgus deformity today. At the same time, as a result of scarf osteotomy, the pathological hallux valgus interphalangeal angle (HVIPA) is not elimi-nated. In order to correct the latter, it is possible to per-form an osteotomy of the base of the main phalanx of the 1st finger (Akin osteotomy). There is a limited amount of objective data comparing the radiological and functional results of treatment of patients with mild and moderate HV deformity who underwent solely either scarf osteo-tomy or scarf osteotomy in combination with additional Akin osteotomy. The aim of the study was to compare the clinical and radiological results of isolated scarf osteo-tomy and a double scarf and Akin osteotomy in patients with mild and moderate HV forefoot deformity. Materials and methods. The study included 187 patients (187 feet) with HV anterior deformity of mild and moderate severi-ty, who were divided into 2 groups. The first group, where Akin surgery was performed in addition to scarf osteoto-my, consisted of 86 patients (86 feet). 101 patients (101 feet) were included in the second group, where only scarf osteotomy was performed. According to all indicators, the patients of the groups were comparable and had no significant differences. The exception was the hallux val-gus interphalangeal angle (HVIPA), which was significant-ly larger in the first group A, since the threshold value for performing an additional Akin osteotomy was the HVIPA value of 9° or more. All patients underwent clinical exam-ination, X-ray control and questionnaires of AOFAS, VAS and MOXFQ scales before surgery, as well as on the 12thand 24th months after surgery. An objective assessment of the quality of hallux valgus deformation elimination was carried out according to three angular indicators: hallux valgus interphalangeal angle (interphalageal an-gle — HVIPA), hallux valgus angle (hallux valgus angle — HVA), the first interplatarsal angle (1–2 intermaetatarsal angle — 1–2 IMA). Results. There was no statistically sig-nificant difference in anatomical and functional results of treatment of patients of the studied groups. In addition, there were no significant changes in the studied indica-tors at 12 and 24 months after surgery, both within each group and in comparison of the groups with each other. Conclusion. To achieve good results when correcting the hallux valgus of the first toe, the anatomy of the phalan-ges of the first toe should be taken into account. Liter-ature data, as well as the results of our studies indicate that correction of valgus deformity of the interphalangeal joint with an HVIPA of 9° or more is recommended to pre-vent loss of correction after osteotomy of the first meta-tarsal. Despite the increase in the traumatic nature of the intervention, Akin osteotomy performed in addition to scarf osteotomy according to appropriate indications does not require correction of the postoperative rehabili-tation program, does not adversely affect the anatomical and functional outcome of treatment, does not lead to an increase in the proportion of complications.

Hallux Valgus Multiplanar Correction Surgery Through a Minimally Invasive Technique. Our Initial Experience.

Category:Bunion; OtherIntroduction/Purpose:Recently, minimally invasive surgery for hallux valgus correction has regained popularity. The minimally invasive Chevron and Akin (MICA), has been proved to be as satisfactory for patients as conventional open techniques. However, due to its design, it is difficult to correct the coronal plane malalignment, which could lead to the recurrence of the deformity.Instead, a Bösch-type osteotomy allows multiplanar correction, and with an upgrade in its fixation we can create a stable third- generation percutaneous osteotomy. We report our early results using the minimally invasive Bösch and Akin osteotomy (MIBA).Methods:This was a prospective case series of our first 40 patients (41 feet) undergoing MIBA procedure. Outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), the AOFAS Forefoot Score, and the visual analog scale (VAS) for pain assessment. Radiographic measures included the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and the pronation of the metatarsal. All complications and emitted radiation dosage were reported as well.Results:At 12 months MOXFQ and AOFAS improved from 54.8 to 0.66 (p=0) and 39.1 to 99.2 (p=0), respectively. The mean preoperative VAS was 5.8, and improved during the first week to 1.3 (p<0.05). There was also a significant improvement in all radiographic parameters. We had two significant and five minor complications.Conclusion:The MIBA procedure is a safe and effective option to achieve a multiplanar hallux valgus correction.

Minimally Invasive Surgery for Severe Hallux Valgus with 2 Year Minimum Follow Up in 106 Feet

Category:Bunion; Lesser Toes; Midfoot/ForefootIntroduction/Purpose:There is widespread variation in the optimal procedure for correction of severe hallux valgus deformity. Severe hallux valgus (defined as hallux valgus angle (HVA) (>=40°) and/or 1-2 intermetatarsal angle (IMA) (>=20°)) is associated with increased complication rates including recurrence, delayed or non-union and metatarsal shortening with transfer metatarsalgia. There is limited evidence investigating the clinical or radiological outcomes following treatment of severe hallux valgus deformity with third-generation minimally invasive chevron and akin osteotomies (MICA). Objective: The primary aim was to investigate clinical patient reported outcome measures (PROMs) two years following surgery and the radiographic deformity correction for patients undergoing third-generation MICA for severe hallux valgus deformity.Methods:Prospective observational single surgeon series of consecutive patients who underwent primary third-generation MICA with screw fixation for severe hallux valgus. The primary outcome was a validated patient reported outcome measure, the Manchester-Oxford Foot Questionnaire (MOXFQ), assessed minimum 2 years following MICA. Secondary outcomes were radiographic deformity correction, complication rates and other quality of life PROMs (EQ-5D and Visual Analogue Pain Scale).Results:Between September 2014 and May 2018, 106 consecutive feet (n=78 patients; 73 female, 5 male) met the inclusion criteria. Prospectively collected pre-operative and 2 year PROM MOXFQ data was available for 86 feet (81.1%). At two years following surgery, the MOXFQ score significantly improved for the Pain, Walking and Standing and Social Interaction domains from 39.2 to 7.5, 38.2 to 5.9 and 48.6 to 5.5, respectively (p<0.001). Pre- and post-operative radiographic data was available for all 106 feet. Mean IMA following surgery improved from 18.2° to 6.3° (p<0.001) whilst mean HVA improved from 45.3° to 10.9° (p<0.001).Conclusion:This study has demonstrated third-generation MICA for the treatment of severe hallux valgus deformity can achieve significant improvements in clinical PROMs and radiographic deformity correction.

Correction of hallux abducto valgus by scarf osteotomy. A ten-year retrospective multicentre review of patient reported outcomes shows high satisfaction rates with podiatric surgery

BackgroundCorrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy.MethodPatient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period.ResultsOf 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was ‘no/less pain’ reported in 70% of patients. 96.8% of patients reported their original foot complaint as ‘better’ or ‘much better’ after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%).ConclusionThe scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ-10 and this information can be used as part of the pre-operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre-operative work up of the patient. Further investigation into this correlation is suggested.Level of clinical evidenceIV (retrospective review).

Analysis of Change in Patient Reported Outcome Measures Following Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Category:BunionIntroduction/Purpose:There is a need to understand the rate of improvement following minimally invasive chevron akin osteotomies (MICA) for correction of hallux valgus deformity using validated patient reported outcome measures (PROMs) and whether this change is clinically meaningful in order to help counsel patients as to their progress.Methods:Between July 2014 and November 2018, data was prospectively collected from consecutive patients pre-operatively and at 6, 12, and 24 months following MICA. The primary outcome measure was the change in Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) score at each timepoint following MICA. Secondary outcomes include radiographic deformity correction, and exploration of cases where PROMs did not improve following MICA.Results:190 feet with complete PROM data at each time point, were identified from a cohort of 334 feet undergoing third generation MICA. There was a statistically significant improvement in MOXFQ score for each MOXFQ domain at each time point following MICA although the majority of the improvement was within the first 6 months. 17 feet had worse MOXFQ Index scores at the six month timepoint compared to pre-operatively. Of these feet, 82.4% (n=14) improved over time such that by two years their score had improved compared to their pre-operative score.Conclusion:There is a statistically significant improvement in MOXFQ score at every time point following MICA for hallux valgus. The majority of patients who scores are worse at 6 months following will go on to have improved function compared to their pre-operative state.

Bilateral vs Unilateral Minimally Invasive Hallux Valgus Surgery: A Propensity Matched Case-Control Study with 2 Year Clinical Patient Reported Outcomes

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Hallux valgus deformity correction using a third-generation Minimally Invasive Chevron Akin osteotomy technique (MICA) is becoming increasingly popular. There is limited patient reported outcome measure (PROM) outcomes for patients undergoing bilateral hallux valgus corrective MICA surgery during a single operative case.Methods:Between July 2014 and May 2018, 59 consecutive patients comprising 118 feet underwent bilateral MICA in a single operative case. 1:1 propensity score matching based on preoperative PROM assessment, age, and radiographic deformity data was carried out to match each foot in the bilateral cohort with 118 feet who had undergone unilateral MICA. The primary outcome measure was the Manchester-Oxford Foot Questionnaire (MOXFQ) which was prospectively measured pre-operatively, six months and two years post-operatively. Secondary outcomes included complication rates and radiographic deformity correction with regards to the hallux valgus angle (HVA) and inter-metatarsal angle (IMA).Results:At minimum 2 year follow up, the MOXFQ post-operative scores had significantly improved for every domain (p <0.001) in both unilateral and bilateral cohorts compared to pre-operative assessment. For all domains of the MOXFQ, there was no statistically significant difference in 6 month or two year outcomes between patients undergoing bilateral and unilateral MICA surgery (p >0.05 for all outcome measures). There was no statistically significant difference between the two cohorts in complication rate (p=>0.05) or post-operative IMA or HVA (p >0.05).Conclusion:This study demonstrates that there is no significant difference in patient reported outcome measured at two year follow-up between patients who underwent bilateral versus unilateral MICA. This study should reassure surgeons who perform bilateral hallux valgus surgery in a single case that, in the medium-term, there is no difference in clinical or radiographic PROMs compared to unilateral surgery. There are potentially positive health economic benefits of performing bilateral surgery in a single sitting if clinically indicated.

Short-term evaluation of combined Scarf and Akin osteotomies for treatment of hallux valgus: a prospective study

Short-term evaluation of combined Scarf and Akin osteotomies for treatment of hallux valgus: a prospective study

Two Year Patient Reported Outcomes of 334 Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:There are many different procedures described for the correction of hallux valgus deformity. Minimally invasive surgery has become increasingly popular, with clinical and radiological outcomes comparable to traditional open osteotomy approaches. There is increasing interest in hallux valgus deformity correction using third-generation minimally invasive chevron akin osteotomy (MICA) technique. Objective: To assess the radiographic correction and 2-year clinical outcomes of third-generation MICA using validated outcome measures.Methods:This is a prospective single-surgeon case series of 420 consecutive feet undergoing MICA surgery between July 2014 and Jan 2019. Primary clinical outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D, and the Visual Analogue Pain Scale. Secondary outcome measures included radiographic parameters, and complication rates.Results:Pre-operative and 2 year post-operative patient reported outcomes were collected for 334 feet (79.5%). At minimum 2 year follow-up, the MOXFQ scores (mean +- standard deviation (SD)) had improved for each domain: pain; pre-operative 43.9+- 21.0 reduced to 9.1+-15.6 post-operatively (p<0.001), walking and standing; pre-operative 38.2+-23.6 reduced to 6.5+-14.5 post- operatively (p<0.001) and social interaction; pre-operative 47.6+-22.1, reduced to 6.5+-13.5 post-operatively (p<0.001). At 2 year follow-up, the VAS Pain score (mean +- SD) improved from a pre-operative of 31.3+-22.4 to 8.3+-16.2 post-operatively (p<0.001). 1-2 intermetatarsal angle (mean +- SD) reduced from 15.4°+-3.5° to 5.8°+-3.1° (p<0.001) and hallux valgus angle reduced from 33.1°+-10.2° to 9.0°+-5.0° post-operatively (p<0.001).Conclusion:Third-generation MICA showed significant improvement in clinical outcomes at 2 year follow-up and can be successfully used for correction of a wide range of hallux valgus deformities.

Minimally Invasive Surgery for Severe Hallux Valgus with Severe Metatarsus Adductus: Case Reports

Category:Bunion; Lesser ToesIntroduction/Purpose:Metatarsus adductus (MA) is a congenital transverse plane deformity with an incidence of approximately 30% in patients with hallux valgus. Operative treatment of hallux valgus (HV) with MA can be clinically challenging, and the recurrence rate of HV has been reported as two times higher than in patients without MA. Minimally invasive surgery (MIS) for the correction of HV is growing in popularity; however, only one study has been published on MIS for HV with MA using percutaneous proximal metatarsal osteotomy. We presented our case reports using distal oblique metatarsal minimal invasive osteotomy (DOMMO) for severe MA.Methods:We corrected two feet using DOMMO for severe MA. Minimally invasive chevron Akin osteotomy (MICA) was utilized to correct severe HV. The patient had subluxations in the second and third metatarsophalangeal joints and hammer toe deformities. Therefore, those deformities were concurrently corrected using percutaneous procedures. The patient was allowed immediate full weight bearing postoperatively in a flat rigid shoe for 6 weeks. Radiographic and clinical evaluations were performed preoperatively and one year after surgery. On the anteroposterior radiograph, the hallux valgus angles (HVA), the first intermetatarsal angles (IMA), tibial sesamoid positions (TSP) and metatarsus adductusangles (MAA) were evaluated. On the lateral weight-bearing radiograph, first metatarsal inclination angles were also evaluated. We also evaluate the Japanese Society for Surgery of the Foot (JSSF) hallux and lesser toes scales and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) both before and after MIS for HV with MA.Results:In the first case, the HVA improved from 50° to 16°, the IMA from 15° to 11°, TSP from 7 to 5 using Hardy's classification, and MAA from 27° to 14.5°, pre- to postoperatively. In the second case, the HVA improved from 45° to 11°, the IMA from 10° to 6.5°, TSP from grade 7 to 3, MAA from 30 to 12, pre- to postoperatively. The first metatarsal inclination angles changed from 16.9° and 18.8° to17.7° and 22.0°, respectively. All subluxations and hammer toe deformities were resolved. Although there were delayed unions in the lesser metatarsals, unions were achieved finally. Preoperative JSSF hallux scales and lesser toes scales were 59 points and 64 points, 67 points and 80 points, respectively. Both hallux and lesser toe scales improved to 100 points one year after surgery. All SAFE-Q subscores were also improved one year after surgery.Conclusion:In conclusion, our MIS procedure, consisting of DOMMO of the second, third, and fourth metatarsals and MICA, could correct severe HV with severe MA. The patient was allowed immediate full weight bearing postoperatively in a flat rigid shoe. Although there were delayed unions in lesser metatarsals, unions were finally achieved and good results were demonstrated both radiographically and clinically.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

Category:BunionIntroduction/Purpose:Some authors reported the results from the third-generation minimally invasive chevron Akin osteotomy (MICA) to treat mild to moderate hallux valgus recently. However, there have been few studies evaluating the results of MICA for moderate to severe hallux valgus. The purpose of this study was to evaluate the radiographic and clinical results of MICA for correction of moderate to severe hallux valgus.Methods:A prospective review of 30 patients (40 feet) that underwent MICA for moderate to severe hallux valgus was conducted. The 28 feet (70%) were classified as severe deformity (hallux valgus angle (HVA) >= 40°and/or first intermetatarsal angle (IMA) >= 18°). Mean followup was 18.6 months. On the anteroposterior weightbearing radiographs, HVA, IMA, lateral shape of metatarsal head (round sign), tibial sesamoid position, and first metatarsal shortening were measured. On the lateral weightbearing radiographs, inclination angle of first metatarsal was measured. American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS) scores and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the most recent follow-up.Results:Mean HVA reduced from 39.3° to 12.8°and mean IMA reduced from 18.6° to 8.4° postoperatively. Incidence of positive round sign of metatarsal head reduced from 57.5% to 5%. Tibial sesamoid position improved from 6.7 to 4.7 using Hardy's classification. Average first metatarsal shortening was 2.8mm. Inclination angle did not changed significantly, from 20.5°to 21.1°. Mean AOFAS score improved from 65.3 points to 97.9 points. All SAFE-Q subscores also significantly improved postoperatively. There were 5 complications required surgeries: 2 metatarsal screw removals and 3 bone eminence resections. There were some other complications including 3 under-correction cases and one numbness for at least 6 months.Conclusion:MICA could improve moderate to severe hallux valgus both radiographically and clinically. Accordingly, our results suggest that this procedure provides an effective means of correcting hallux valgus regardless of severity of deformity.

Correlation of Loss of Correction With Postoperative Radiological Factors After Distal Chevron Osteotomy in Dependence of Concomitant Akin Osteotomy

Loss of correction is frequently observed following hallux valgus correction and is associated with recurrence of a hallux valgus deformity. The purpose of this study was to correlate loss of correction and radiological parameters following distal chevron (Group C) and combined chevron/akin (Group AC) osteotomy. A total of 859 feet were included for analysis and grouped according to treatment with a distal chevron osteotomy alone or a combined chevron/akin osteotomy. Radiographs were evaluated preoperatively, postoperatively, after 6 weeks, 3 months and, if available, at long term follow-up with a mean of 34.2 (range 7.5-155.3) months. With the exception of the proximal to distal phalangeal articular angle (PDPAA), preoperative deformity was comparable between both groups. Significant correction of all examined parameters (p < .001) was seen. Loss of correction at 6 weeks with minor deterioration until follow-up was also detected, with group AC somewhat better than Group C. A strong correlation with loss of correction was found for the postoperative hallux valgus angle (HVA) (p < .002), intermetatarsal angle (IMA) (p < .001), distal metatarsal articular angle (DMAA) (p < .002), positioning of the sesamoids (p < .002) and joint congruity (p < .035) in Group C and for the DMAA (p < .033) and HVA (p < .046) in Group AC. Multiple postoperative radiological parameters correlated with loss of correction following distal chevron osteotomy. In Group AC only postoperative HVA and DMAA determined loss of correction. Correction of the deformity in Group AC showed greater stability.

Technique Tip: Medial prominence bone spur resection in the third-generation percutaneous Chevron-Akin Osteotomy Technique (PECA) for hallux valgus correction

The third-generation percutaneous chevron and Akin osteotomy (PECA) technique for surgical management of hallux valgus has shown improvement in clinical and radiographic outcomes. During this procedure, lateral translation and fixation of the first metatarsal head results in the formation of a bony prominence on the medial side of the distal aspect of the first metatarsal which can cause pain and discomfort to the patient. We describe two techniques to address this bony prominence; either i) excision osteotomy and removal of the fragment or ii) a dorsal closing wedge osteotomy retaining the bony fragment. Level of EvidenceLevel V, expert opinion

Minimally Invasive Chevron Surgery and Bosch Percutaneous Osteotomy in Hallux Valgus Treatment. Midterm Results. Comparative Radiological Study.

Objective The purpose of the present study is to compare the radiological results of angular correction and its maintenance in the medium term between two minimally invasive techniques for the treatment of hallux valgus (minimally invasive chevron surgery vs. Bosch technique). Methods A comparative prospective analysis of patients undergoing surgery for symptomatic hallux valgus deformity was performed. We compared two minimally invasive techniques in homogeneous groups of population. Two groups of 62 and 63 feet respectively, were constituted. We compared first ray angular corrections and consolidation as well as the correction power of both osteotomies and their maintenance over time. The postoperative complications and surgical time in both study groups were also evaluated. The minimum follow-up was 2 years. Results There were differences between both groups in the intermetatarsal angle at 24 months postsurgery. There were no differences between both groups regarding metatarsophalangeal angle, and distal metatarsal articular angle. There were no intraoperative complications in either group. The surgical time between both groups had statistically significant differences. Conclusions Both screw-stabilized, Bosch surgery and minimally invasive chevron (hybrid when associated with percutaneous Akin osteotomy) present adequate correction of moderate hallux valgus. However, patients treated with Bosch percutaneous surgery had a greater correction power of the intermetatarsal angle in the medium term, as well as a shorter surgical time, when compared with those who were treated with chevron osteotomy. Both techniques had a similar evolution over time regarding loss of correction and postoperative complications.

Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis.

Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities.

Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically. Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up. All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved. MICA improved moderate to severe hallux valgus both radiographically and clinically.Level of Evidence: Level IV: case series.

Minimally invasive hallux valgus correction with Internal Hallux Fixator® — A comparative cadaver study

BackgroundThe Internal Hallux Fixator® (IHF®; Waldemar Link, Hamburg, Germany) was designed for open surgical hallux valgus correction. It allows a defined lateralisation of the first metatarsal head after V-shaped, Chevron-like distal metatarsal osteotomy in order to correct mild to middle hallux valgus deformities. The intramedullary fixation provides dynamic compression of the osteotomy and thus postoperative full weight bearing mobilization is an integral part of the therapy.This comparative cadaver model study investigates the feasibility of implanting the device using a minimally invasive technique and compares its capability of first metatarsal head lateralisation to the established 3rd generation MICA (Minimally Invasive Chevron and Akin osteotomy) technique. Methods16 fresh frozen cadaveric feet (8 left, 8 right) of 8 body donors received either MICA (Group 1), or an IHF® in a minimally invasive technique (Group 2). The achievable first metatarsal head lateralisation and operating time were measured and pitfalls recorded. ResultsThis cadaver model study confirmed, the minimally invasive implantation of the Internal Hallux Fixator® can be performed reliably via 10 mm mini incision with V-shaped distal metatarsal osteotomy. The mean first metatarsal head lateralisation was comparable between the groups with no statistically significant difference (7.2 (±1.9) mm in G1, or 8.3 (±0.8) mm in G2; p = 0.09).The IHF® was inserted and fixed in mean 3.7 (±0.6) min, whereas double screw fixation needed 10 (±3.7) min. Level of Clinical Evidence5, Cadaver model study.

Percutaneous Chevron and Akin (PECA) Osteotomies for Severe Hallux Valgus Deformity With Mean 3-Year Follow-up.

Patients with severe hallux valgus deformity present technical and operative challenges with high rates of recurrence and residual deformity. The clinical and radiologic outcomes of percutaneous surgery for severe hallux valgus are not known. A retrospective review of consecutive patients with a hallux valgus angle (HVA) >40 degrees or intermetatarsal angle (IMA) >20 degrees who underwent third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus deformity correction. Between December 2012 and August 2019, 59 feet in 50 patients underwent PECA. Preoperative and follow-up radiographic data were available for 53 feet (89.8%). Postoperative clinical patient-reported outcome measures and satisfaction results were available for 51 feet (86.4%). The mean clinical and radiographic follow-up was 3.1 years and the mean postoperative Manchester-Oxford Foot Questionnaire Index score was 15.1. There was a statistically significant improvement (P < .001) in both IMA and HVA following surgery (IMA 17.5-5.1 degrees; HVA 44.1-11.5 degrees). All patients reported they were satisfied with their outcome, with 76.8% reporting they were highly satisfied. The hallux valgus recurrence rate was 7.5%. Percutaneous surgery for severe hallux valgus deformity can achieve a large deformity correction, patient satisfaction, and quality of life, with reasonable rates of residual deformity and low rates of recurrence. Level IV, case series.