Comparison Between Mini-Invasive Distal and Proximal Chevron Osteotomies in the Correction of Hallux Valgus Deformity

CATEGORY: Bunion INTRODUCTION/PURPOSE: The potential advantages of minimal incision surgery for hallux aboducto valgus (HAV) correction are to reduce surgical exposure, diminish soft-tissue stripping, and lessen blood supply impairment. The purpose of this study was to assess the safety and efficacy of minimally invasive techniques. Currently, there are insufficient studies to recommend one minimally invasive technique over another. METHODS: From 2018 to 2020, 141 cases with hallux abducto valgus were treated with minimal incision osteotomy using Kirschner wire fixation. 120 patients had distal chevron osteotomies and 21 patients had proximal first metatarsal osteotomies. The patient age range was between 29 yo and 96 yo, with 118 female and 23 male patients. 48 patients were 65 yo and over, and 93 patients were less than 65yo. The preoperative and postoperative hallux abducto valgus angles (HVA), intermetatarsal angles (IMA), American Orthopaedic Foot & Ankle Society (AOFAS) scores were measured and evaluated. RESULTS: The average AOFAS scores improved from a preoperative median of 41.4 points to a postoperative median of 88.6 points. The mean HVA and IMA angles significantly decreased after the operation. There were no complications of nonunion or delayed union, avascular necrosis, infection, or hallux varus. The technique has been largely accepted by the patients due to the short procedure time, the reduced postoperative pain, and the fast functional recovery. For the hallux aboducto valgus deformity with HVA over 35 and IMA over 16 degrees, the procedure with proximal chevron osteotomy achieved better corrections. CONCLUSION: Both proximal and distal chevron osteotomy techniques showed comparable results. The distal percutaneous osteotomy was effective for the treatment of mild to moderate hallux abducto valgus deformity, and the proximal percutaneous osteotomy was effective for the treatment of severe hallux abducto valgus deformity. This study indicated that the minimal incision osteotomy was a simple and reliable technique for treating hallux abducto valgus with minimal complications. Through minimally invasive approaches, the hallux abducto valgus corrections performed in this study resulted in minimal soft tissue injury, less postoperative pain, and good cosmetic results.