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Category:   Midfoot/ForefootIntroduction/Purpose:   The effectiveness of minimally invasive surgery (MIS)-distal chevron metatarsal osteotomy (DCMO) for the correction of moderate to severe hallux valgus deformity is unclear. Traditionally, proximal chevron metatarsal osteotomy (PCMO) has been considered a reliable procedure for correcting severe hallux valgus deformity. This study aimed to clarify the clinicoradiographic outcomes of our novel MIS-PCMO technique and compared its outcomes to those of MIS-DCMO performed during the same timeframe. We addressed the following research questions: (1) can the MIS-PCMO technique be an effective option for correcting moderate to severe hallux valgus deformity?; (2) are there differences in the extent of deformity correction possible with MIS-PCMO and MIS-DCMO?; and (3) what points should be considered before performing the MIS-PCMO technique?Methods:   We prospectively compared the outcomes of patients who underwent MIS-PCMO (n=20 patients; 22 surgeries) and those of patients who underwent MIS-DCMO (n=23 patients; 26 surgeries) for moderate to severe hallux valgus deformity (hallux valgus angle [HVA] &gt;=30o) between January 2017 and December 2018. The minimum follow-up duration for inclusion in this study was 18 months. The HVA, first-to-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative length of the second metatarsal, medial sesamoid position, and Meary angle were measured preoperatively and at the final follow- up.Results:   Compared to MIS-DCMO, MIS-PCMO resulted in significantly greater correction of the HVA (P&lt;0.001) and IMA (P=0.01), along with Meary angle improvement (P&lt;0.001); however, the DMAA worsened (P=0.01). Furthermore, there was a significantly greater change in the relative second metatarsal length in the MIS-DCMO group (P=0.01). There were no significant between-group differences in the correction of the medial sesamoid position (P=0.445).Conclusion:   MIS-PCMO can be a better option for correcting moderate to severe hallux valgus deformities than MIS-DCMO. However, this technique should be applied carefully when the preoperative DMAA is already large because the DMAA can become worse postoperatively.

Outcomes of Minimally Invasive Proximal Chevron Metatarsal Osteotomy for Moderate to Severe Hallux Valgus Deformity