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Updated: Sep 15, 2025

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Time to Radiographic Union Following Minimally Invasive META Procedure for Hallux Valgus.

Taylor Schnepp1, Kyle Lorenzo2, Chase Burzynski3

  • 1Baptist Health Orthopedic Institute, Coral Gables, FL, USA.

Foot & Ankle Orthopaedics
|July 14, 2025
PubMed
Summary

Fourth-generation minimally invasive hallux valgus surgery (META) shows good union rates by 13 weeks, regardless of metatarsal displacement. This aids in planning weight-bearing for patients.

Keywords:
bunionfoot and anklehallux valgusminimally invasivetime to union

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Area of Science:

  • Orthopaedic surgery
  • Foot and ankle surgery
  • Minimally invasive surgery

Background:

  • Fourth-generation minimally invasive surgery (MIS) for hallux valgus, known as META, involves metaphyseal extra-articular transverse and Akin osteotomy.
  • This technique is associated with favorable functional outcomes and low complication rates in recent literature.
  • Orthopaedic trauma literature suggests 2-3 neocortices indicate a high likelihood of bony union.

Purpose of the Study:

  • To evaluate the time to bony union in patients undergoing fourth-generation MIS hallux valgus repair (META procedure).
  • To determine the relationship between the degree of first metatarsal displacement and the time to bony union.

Main Methods:

  • Retrospective analysis of 217 patients with moderate to severe hallux valgus treated with META between 2020-2023.
  • Radiographic assessment of first metatarsal displacement percentage and neocortical bridge formation.
  • Follow-up at 6 weeks, 3 months, 6 months, and 1 year to assess union and clinical outcomes.

Main Results:

  • 92% of patients achieved bony union by the final follow-up (mean 13 weeks).
  • Union rates were 17% at 6 weeks, 70% at 3 months, and 90% at 6 months.
  • No significant difference in time to union was found across different degrees of metatarsal shift.

Conclusions:

  • Bony union after the META procedure typically occurs by 13 weeks, irrespective of the magnitude of metatarsal shift.
  • The presence of at least 2 new cortices and absence of symptoms may be sufficient indicators for advancing weight-bearing.
  • Findings can inform patient counseling and postoperative management strategies.