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Preliminary Radiographic Classification of First Metatarsal Osteotomy Healing Following Minimally Invasive Hallux

Thomas L Lewis1, Sanjana Mehrotra2, Jonathan Kaplan3

  • 1Orthopaedics and Arthritis Specialist Centre, Sydney, Australia.

Foot & Ankle Orthopaedics
|July 3, 2025
PubMed
Summary

A new radiographic classification system reliably assesses first metatarsal bone healing after minimally invasive surgery (MIS) for hallux valgus. This tool shows substantial interobserver reliability and correlates well with CT scans, aiding future research.

Keywords:
ROC curvebone healingclassification systemhallux valgusinterobserver reliabilityminimally invasive surgerypercutaneous osteotomyradiographic assessmentreliabilityweightbearing CT

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Foot and ankle surgery

Background:

  • Minimally invasive surgery (MIS) for hallux valgus correction is increasingly adopted.
  • Positive clinical and radiographic outcomes are reported for MIS hallux valgus surgery.
  • A standardized radiographic classification for first metatarsal osteotomy healing after MIS is lacking.

Purpose of the Study:

  • To develop a novel radiographic classification system.
  • To assess bone healing following MIS distal transverse osteotomy for hallux valgus.
  • To establish a standardized method for evaluating MIS hallux valgus osteotomy healing.

Main Methods:

  • A 4-domain radiographic classification system was developed (callus, AP osteotomy line, lateral osteotomy line, remodeling).
  • The system was tested on 27 feet undergoing percutaneous transverse osteotomy for hallux valgus.
  • Weightbearing computed tomography (WBCT) and standard radiographs were used; 5 surgeons assessed interobserver reliability.

Main Results:

  • Substantial interobserver reliability was found for lateral (κ=0.671) and AP osteotomy lines (κ=0.664).
  • Moderate agreement was observed for callus formation (κ=0.465) and remodeling (κ=0.439).
  • The classification showed strong correlation with WBCT, achieving 85.2% accuracy in differentiating union from nonunion.

Conclusions:

  • The developed classification is a reliable tool for assessing first metatarsal bone healing post-MIS hallux valgus osteotomy.
  • It offers a standardized approach for radiographic evaluation, potentially improving study comparability.
  • Further validation is needed to determine its clinical applicability.