Increased Risk of Recurrence in Severe Hallux Valgus Associated With Inability to Passively Correct Deformity Prior...

The optimal osteotomy technique for severe hallux valgus deformity using minimally invasive surgery remains unknown. This study aimed to explore the clinical and radiographic outcomes between chevron and transverse osteotomies in patients with severe hallux valgus deformity.

A retrospective cohort study was conducted including 131 feet (109 patients) with complete radiographic follow-up who underwent hallux valgus correction using either percutaneous chevron and Akin osteotomy (PECA) (n = 43 patients, 50 feet) or metaphyseal extra-articular transverse and Akin osteotomy (META) (n = 66 patients, 81 feet) techniques. Radiographic parameters including hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured at baseline, 6 weeks, and final follow-up. Patient-reported outcome measures were assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ), visual analog scale (VAS) for pain, and EuroQol 5 dimension-5 level questionnaire. Recurrence was defined as a final HVA exceeding 20°. Complication rates and passive correctability were also analyzed.

Baseline characteristics were similar between groups, except for significantly higher initial IMA in the PECA group (17.8° vs 15.8°, P = .001). Both techniques achieved significant deformity correction. At final follow-up, the PECA group demonstrated a significantly lower HVA compared to the META group (11.7° vs 14.5°, P = .045), whereas final IMA measurements were similar (5.2° vs 4.9°, P = .642). Recurrence rates were significantly lower in the PECA group (10.0% [95% CI: 4.3%-21.4%] vs 27.2% [95% CI: 18.7%-37.7%], P = .025). Pre-operative passive correctability was significantly higher in the PECA group (68.0% vs 46.9%, P = .020), particularly amongst recurrent cases (80.0% vs 27.3%, P = .047). No significant differences were observed in MOXFQ scores between groups, although VAS pain favored the META group (6.2 [SD 12.3] vs 11.9 [SD 17.5], P = .046). Complication rates were comparable (PECA: 13.2% vs META: 8.6%, P = .40). Complication rates were comparable (PECA: 13.2% vs META: 8.6%, P = .40), with different complication profiles noted between techniques.

Both PECA and META techniques provide effective correction of hallux valgus deformity. The higher recurrence rate observed in the META group was associated with a significantly lower rate of pre-operative passive correctability in that cohort.

Level III, retrospective comparative study.