Fourth generation minimally invasive osteotomy with rotational control for hallux valgus: a case series

Abstract

Objective: Demonstrate the clinical and radiographic results of patients with hallux valgus (HV) treated by a fourth generation minimally invasive technique with rotational control of the first metatarsal. Methods: Twenty-two patients were included in the study. All patients were women, with 14 right and eight left feet, with a mean follow-up of 15 months (12–18). The radiographic parameters evaluated were the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the sesamoid displacement (Hardy Clapham), and the shape of the lateral edge of the first metatarsal head. The American Orthopaedic Foot and Ankle Score (AOFAS) score, visual analog scale (VAS), and complications were also evaluated. Results: The HVA improved from the preoperative (26.8°) to the postoperative (4.2°) and the IMA from 13.2° to 2.7°. Regarding sesamoids, in the preoperative, three patients were grade 6, 10 were grade 5, and nine were grade 4. In the postoperative, ten patients were grade 2, and 12 were grade 1. In the preoperative, the lateral edge of the first metatarsal head was intermediate type in 18 patients and round type in four patients. In the postoperative, all patients were classified as angular type. The mean AOFAS increased from 45 to 91 points, and the mean VAS decreased from 6 to 1. The most common complication was surgical scar adherence in four patients. Conclusion: The fourth generation minimally invasive technique with rotational control presented triplanar correction of the HV deformity. In addition, it provided pain improvement and functional gain with a low rate of complications. Level of Evidence IV; Therapeutic Studies; Case Series.