Third-generation minimally invasive correction of hallux valgus: technique and early outcomes

There is growing evidence supporting minimally invasive surgical (MIS) techniques for correction of symptomatic hallux valgus. The aim of this study was to present a hybrid third-generation technique and assess the safety and efficacy from the first 45 procedures. Forty-five consecutive feet underwent a third-generation MIS distal chevron osteotomy with a minimum six month follow-up (range six to 17 months). This technique uses both first- and second-generation techniques plus a distal chevron osteotomy and screw for improved control and stabilisation of the metatarsal head. All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsal length and overall toe length. There were significant improvements in all three domains of the MOXFQ (p < 0.001). There was also significant improvement in all radiographic parameters (p < 0.001). Mean HVA decreased from 30.54A degrees to 10.41A degrees, and the mean IMA decreased from 14.55A degrees to 7.11A degrees. Shortening of the first metatarsal had no effect on clinical outcomes. There was a very low rate of complications. The short-term results of this third-generation technique show that it is a safe procedure with good clinical outcomes and compares favourably with earlier techniques.