MICA for all hallux valgus severity grades: A retrospective outcome study

Surgical treatment for hallux valgus (HV) has traditionally been guided by deformity severity. Severe HV was typically addressed with proximal corrections, while mild to moderate cases received distal osteotomies. Recent studies suggest that even severe HV can be effectively managed using minimally invasive distal techniques.

To evaluate outcomes of the Minimally Invasive Chevron and Akin (MICA) procedure across HV severity grades and assess the relevance of traditional severity-based classification in surgical decision-making.

Retrospective clinical measurement study with radiographic and patient-reported outcomes analysis.

A single-center retrospective study included 120 feet (111 patients) treated with MICA for isolated HV between 2016 and 2022. Radiographic and Patient-Reported Outcome Measures (PROMs) were assessed with a minimum two-year follow-up. Deformities were classified as severe or non-severe (mild-moderate) based on standard angular thresholds.

Thirty-two cases (26.7 %) were classified as severe and 88 (73.3 %) as non-severe. Median (IQR) pre-operative and post-operative first intermetatarsal angles (IMA1) were 14.0 (11-16) and 2.6 (1.3-4.8) degrees, respectively. Median pre-operative and post-operative hallux valgus angles (HVA) were 31.2 (26-38) and 8.8 (4.2-11.6) degrees. Median EFAS scores were 19 for severe and 22 for non-severe groups (p = .228). Satisfaction rates were comparable with 84 % in the severe group and 83 % in the non-severe group. PROMs were not associated with preoperative HV severity (p > .1).

MICA is effective across all HV severity grades, challenging the need for traditional severity-based classification in surgical planning.