Percutaneous double osteotomy of the first metatarsus for correction of severe hallux valgus deformity

Background The goal of operative treatment of severe hallux valgus (HV) is to offer relief of pain, correction of forefoot deformity, and a biomechanically functional foot. However, the authors are constantly exploring ways of moving from open surgery to minimally invasive techniques, replacing large incisions with small ‘ports’ through which the surgeon works. Percutaneous less-invasive techniques have been successfully used for mild to moderate HV deformities; however, controversy exists for their use in cases with more severe involvement. Aim The aim of this prospective study was to assess the clinical and radiological outcomes of a percutaneous minimally invasive technique for the management of severe HV deformity. Patients and methods Between July 2013 and June 2015, 36 feet in 24 active patients, comprising 18 female and six male patients, where 12 patients had bilateral involvement, met the selection criteria for symptomatic severe HV deformity and treated by a minimally invasive double metatarsal osteotomy technique. The procedure implied simple transverse-osteotomy, with lateral translation, of the first metatarsus both proximally and distally combined with selective distal soft-tissue dissection. Average patients’ age was 39.8 years. Clinically, the American Orthopedic Foot and Ankle Society score and the subjective patient satisfaction were evaluated. Radiologically, HV angle, distal metatarsal articular angle, intermetatarsal angle, and joint congruity were measured preoperatively, postoperatively, and at the end of the follow-up period. All data were statistically analyzed. Results The mean follow-up period was 21.3 months (range: 18–24 months). Union was achieved in all osteotomies in a mean of 6.67±0.45 weeks. Each radiological and clinical parameter showed a statistically significant improvement (P<0.001), with a negligible first-ray shortening (P=0.547) and a few complications. At the end of follow-up period, no patient was dissatisfied. Conclusions Percutaneous double first metatarsal osteotomy technique with selective distal soft-tissue dissection provides a simple, adequate reproducible procedure, and effective alternative for treatment of severe HV deformity in a minimally invasive procedure.