Third-Generation Minimally Invasive Chevron and Akin Osteotomies (MICA) in Hallux Valgus Surgery

Abstract

Background: There is interest in hallux valgus deformity correction using internal fixation with the minimally invasive chevron and Akin osteotomies (MICA) technique. The objective of this study was to assess the correction measured on postoperative radiographs and clinical outcomes, using validated outcome measures, at 2 years following third-generation MICA. Methods: This is a prospective single-surgeon case series of 333 consecutive feet that underwent MICA surgery between July 2014 and April 2018. The primary clinical outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5 Dimensions-5 Level (EQ-5D-5L) Index, EuroQol-visual analogue scale (EQ-VAS), and a VAS for pain (VAS-pain). Secondary outcome measures included radiographic parameters and complication rates. Results: Preoperative and 2-year postoperative patient-reported outcome measures (PROMs) were collected for 292 feet (87.7%). At a minimum 2-year follow-up, the MOXFQ scores (mean ± standard deviation [SD]) had improved in each domain—i.e., reduced from 44.5 ± 21.0 preoperatively to 9.4 ± 15.8 postoperatively for pain (p < 0.001), from 38.7 ± 23.4 to 6.5 ± 14.6 for walking and standing (p < 0.001), and from 48.0 ± 22.3 to 6.6 ± 13.5 for social interaction (p < 0.001). The VAS-pain score improved from 31.4 ± 22.7 preoperatively to 8.4 ± 16.4 at the 2-year follow-up (p < 0.001), the 1-2 intermetatarsal angle was reduced from 15.3° ± 3.6° preoperatively to 5.7° ± 3.2° at the 2-year follow-up (p < 0.001), and the hallux valgus angle was reduced from 32.9° ± 10.2° to 8.7° ± 5.2° (p < 0.001). Conclusions: The third-generation MICA provided significant improvement in clinical outcome measures at the 2-year follow-up and can be successfully used for correction of a range of hallux valgus deformities with a low rate of symptomatic recurrence. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Third-Generation Minimally Invasive Chevron-Akin Osteotomy for Hallux Valgus Produces Similar Clinical and Radiological Outcomes as Scarf-Akin Osteotomy at 2 Years: A Matched Cohort Study

“…One potential disadvantage of this technique is the decreased stability of the metatarsal osteotomy fixation with only 1 dorsal screw. 13 Recent literature supports the use of the increasingly popular MICA technique as described by Redfern et al, 23-25,42 and our study provides a timely comparison of this technique against the well-established scarf-Akin osteotomy.…”

“…In a series of 40 MICA cases, Holme et al 17 reported improvement in AOFAS scores from 48 to 93, HVA from 32 to 12 degrees, and IMA from 13 to 7 degrees. More recently, in a larger series of 292 MICA cases, Lewis et al 24 reported improvement in each domain of the Manchester-Oxford Foot Questionnaire (MOXFQ) score; HVA also improved from 32.9 to 8.7 degrees, and IMA improved from 15.3 to 5.7 degrees. However, the available literature on the MICA technique is still limited and developing, especially compared with the widely established scarf-Akin osteotomy procedure that has long-term data of up to 10 years reported.…”

“…8,15,19 The latest third-generation (3G) MIS techniques include the minimally invasive chevron-Akin (MICA) technique, 42 which has been reported to yield good clinical outcomes including significantly reduced pain scores. 21,23,24,25,29…”

Pre- and Post-Operative Relationship between Radiological Measures and Clinical Outcomes in Women with Hallux Valgus

“…There is evidence that females younger than 65 years with HV had a statistically significantly worse quality of life than females of the same age group in the general population [26], and that HV surgery resulted in decreased body pain and improved physical function and patient quality of life [27]. More than 100 different procedures for treating hallux valgus have been described [28]; they include combinations of soft tissue balancing, bone osteotomies and joint fusion.…”

What’s New in Foot and Ankle Surgery

“…Two large case series showed the results of minimally invasive chevron and Akin osteotomies for hallux valgus correction. At a minimum follow-up of 2 years, Lewis et al 16 noted significant improvement in all radiographic parameters, VAS pain scores, and all domains of the Manchester-Oxford Foot Questionnaire in 292 cases. There were 3 recurrences (0.9%).…”