Percutaneous Hallux Valgus: An Algorithm for the Surgical Treatment

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery
• Minimally Invasive Procedures

Background:

• Hallux valgus, a common foot deformity, often requires surgical intervention.
• Percutaneous surgical techniques offer potential advantages in soft tissue preservation and cosmesis.
• A tailored approach based on radiographic classification is crucial for optimal surgical outcomes.

Purpose of the Study:

• To evaluate the clinical and radiographic outcomes of hallux valgus surgical correction.
• To assess the efficacy of four distinct percutaneous surgical techniques.
• To correlate technique selection with a predefined radiographic classification system.

Main Methods:

• Prospective evaluation of 112 feet in 72 patients undergoing hallux valgus surgery over one year.
• Four percutaneous techniques were employed: Distal Soft Tissue Release and Akin (DSTR-Akin), Percutaneous Chevron (PCH), Reverdin-Isham (RI) osteotomy, and Ludloff-like Percutaneous Proximal Osteotomy Fixed (PPOF).
• Technique selection was based on hallux valgus angle (HVA), distal metatarsal joint angle, and intermetatarsal angle (IMA).

Main Results:

• Significant reductions in mean HVA and IMA were observed across all techniques.
• The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score improved from 49.2 to 88.6.
• A complication rate of 11% was reported, with comparable outcomes to traditional methods.

Conclusions:

• The presented percutaneous surgical protocol effectively corrects hallux valgus with favorable clinical and radiographic results.
• These minimally invasive techniques provide advantages such as reduced soft tissue trauma and improved cosmetic outcomes.
• The study supports a classification-guided approach for selecting appropriate percutaneous hallux valgus correction methods.