Abstract
Objective To present the clinical and radiographic results of hallux valgus surgical correction
using four percutaneous techniques, chosen according to a predefined radiographic
classification.
Methods We prospectively evaluated 112 feet in 72 patients with hallux valgus operated over
the course of 1 year. Percutaneous distal soft tissue release (DSTR) and the Akin
procedure (DSTR-Akin) were performed in mild cases. In mild to moderate hallux valgus
with distal metatarsal joint angle > 10°, we added the Reverdin-Isham (RI) osteotomy.
In moderate cases with joint incongruity, we performed the percutaneous chevron (PCH).
Finally, a Ludloff-like percutaneous proximal osteotomy fixed (PPOF) with a screw
was proposed in severe cases with an intermetatarsal angle (IMA) > 17°. According
to these criteria, 26 DSTRs-Akin, 36 PCHs, 35 RIs, and 15 PPOFs were performed. The
mean follow-up was of 17.2 months (range: 12 to 36 months). The mean age at operation
was 58.8 years (range: 17 to 83 years), and 89% of the patients were female.
Results The mean preoperative hallux valgus angle (HVA) and the IMA decreased from 21° to
10.2° and from 11.2° to 10.3° respectively in the DSTR-Akin. In the RI, the mean HVA
decreased from 26.6° to 13.7°, and the IMA, from 11.2° to 10.3°; in the PCH, the mean
HVA decreased from 31° to 14.5°, and the IMA decreased 14.9° to 10.7°; as for the
PPOF, the mean HVA decreased from 39.2° to 17.7°, and the IMA, from 11.8° to 6.8°.
The average ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society
(AOFAS) increased from 49.2 to 88.6. The rate of complications was of 11%.
Conclusion Our treatment protocol does not differ much from the classic ones, with similar results
as well. We have as advantages less aggression to soft tissues and better cosmetic
results. Level of Evidence: level IV, prospective case series.
Keywords
hallux valgus - metatarsal bones - minimally invasive surgical procedures
