SLR - September 2021 - Hannan Zahid

Third-Generation Minimally Invasive Chevron and Akin Osteotomies (MICA) in Hallux Valgus Surgery: 2 year follow-up of 292 Cases

Reference: Lewis TL, Ray R, Miller G, Gordon DJ. Third-Generation Minimally Invasive Chevron and Akin Osteotomies (MICA) in Hallux Valgus Surgery: Two-Year Follow-up of 292 Cases. J Bone Joint Surg Am. 2021 Jul 7;103(13):1203-1211.

Level of Evidence: IV

Scientific Literature Review

Reviewed By: Hannan Zahid, DPM
Residency Program: SSM Health DePaul Hospital – St. Louis, MO

Podiatric Relevance: Minimally invasive surgery for the treatment of hallux valgus deformities, in particular third generation, which involves screw fixation of the distal metatarsal osteotomy site, lacks evidence-based patient reported outcome measures (PROMs). Previous studies are at high risk of bias due to the limited number of studies, small samples sizes, inconsistent techniques, short follow up times, large variability of reported complications and unvalidated outcomes. The aim of this study is to bring forth evidence-based clinical outcome measures at two-year follow up.

Methods: Two hundred thirty patients (333 feet) underwent minimally invasive Chevron and Akin osteotomies for the treatment of hallux valgus by a single surgeon. Primary clinical outcome measures assessed by Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5 Dimensions-5 Level (EQ-5D-5L) Index, EuroQol-visual analogue scale (EQ-VAS), and VAS for pain (VAS-pain) were used. Secondary outcome measures were evaluated by measuring radiographic post-operative deformity correction and complication rates.

Results: Primary clinical outcome measures collected on 292 feet demonstrated improvement across all domains of the MOXFQ including walking, pain, and social interaction. Radiographically, the 1-2 IM angle reduced from 15.3 degrees ± 3.6 degrees to 5.7 degrees ± 3.2 degrees and hallux valgus angle from 32.9 degrees ± 10.2 degrees to 8.7 degrees ± 5.2 degrees.

Conclusions: Because of the steep learning curve associated with MIS hallux valgus surgery, the results from this study cannot be generalized. Once the surgeon becomes proficient with the procedures, the MIS approach can offer significant improvement in pain and function and is a viable option. More studies like this with higher diversity of surgeons are needed to objectively assess the efficacy of such procedures. 

Educational Opportunities