Third-Generation Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus

Abstract

Background: Multiple operative techniques have been developed for hallux valgus with varying success. The most recent developments in minimally invasive surgery have evolved into the third-generation minimally invasive chevron Akin (MICA) osteotomy. Good results have been shown from originator centers, but this is one of the first series from a nonoriginator center, and the first to use a validated patient-reported outcome measure. Methods: Forty consecutive patients undergoing third-generation MICA for hallux valgus were included. Primary outcome measures included Manchester-Oxford Foot Questionnaire (MOXFQ) and American Orthopaedic Foot & Ankle Society (AOFAS) scores and Coughlin satisfaction rates at 12 months. Secondary outcome measures included radiographic parameters, complications, and recurrence rates. Results: At 12 months, the MOXFQ score improved from 58 to 10 and the AOFAS score improved from 48 to 93, with 70% of patients reporting excellent outcomes and 30% good ones. Two cases started as mild, 29 cases as moderate, and 9 cases as severe as defined by radiographic criteria. Hallux valgus angles improved from 32 degrees to 12 degrees, and intermetatarsal angles improved from 13 degrees to 7 degrees. There were 4 cases of Akin screw removal for soft tissue irritation. There were no other complications, including recurrence. Conclusion: The third-generation MICA technique was a safe and effective approach to treating hallux valgus. Further research should focus on long-term outcomes and comparative data with other commonly performed operative techniques. Level of Evidence: Level IV, case series.

Minimally invasive Chevron-Akin osteotomy

“…2020;14(3):264-8 popular with foot and ankle surgeons for HV repair (11) . While there are some studies demonstrating the promising results of the MICA technique (12)(13)(14) , there is still a lack of scientific evidence proving its superiority over traditional procedures (11) . Moreover, some authors still question the procedure's advantages and reproducibility (15) .…”

“…Moreover, some authors still question the procedure's advantages and reproducibility (15) . It is also important to point out that although there are some case reports using the technique in the literature (12)(13)(14) the majority of authors, including those who have criticized the technique in their papers (15) , included modified versions of the procedure and did not reproduce the technique as originally described by Redfern and Vernois (10) .…”

Classification of Hallucal Sesamoid Bone Correlated with Hallux Valgus Severity

“…In clinic, patients with sesamoid bone below the first metatarsal head were three to five times more likely to suffer HV, and Chevron Akin Osteotomy is one of the most widely studied and widely used kinds of research [2][3][4][5][26][27][28][29][30][31]. The measurement about 302 HSBs on 150 dry metatarsals from Chinese can help the clinician to master the basic anatomical structure and morphology of the Chinese HSBs, which can improve the anatomical data of it and be helpful in clinical diagnosis and treatment.…”

“…That means HSBs play an important role in reducing load per unit area in the first metatarsal head, especially the tibial side one. Clinically, patients with sesamoid bones below the first metatarsal head were three to five times more likely to suffer HV than patients without sesamoid bone [2][3][4][5]. That means the classification of sesamoids may be a major factor affecting the occurrence and development of HV [6].…”

A New Minimally Invasive Surgery of Hallux Valgus: Technique and Preliminary Outcomes

“…The Endolog technique was reported to have a range from 0 to 10% complication rates and in the distal soft tissue release group from 0 to 4% of cases [12]. During the third-generation technical literatures, the rate of complication was also varied from a 24% [11] or 15.5% [7] or 14% [14] or 10% [16] or 2% [15]. It is possible that a low complication rate might not have included the complications such as stiffness or prominent screws in papers.…”