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Category:   BunionIntroduction/Purpose:   Some authors reported the results from the third-generation minimally invasive chevron Akin osteotomy (MICA) to treat mild to moderate hallux valgus recently. However, there have been few studies evaluating the results of MICA for moderate to severe hallux valgus. The purpose of this study was to evaluate the radiographic and clinical results of MICA for correction of moderate to severe hallux valgus.Methods:   A prospective review of 30 patients (40 feet) that underwent MICA for moderate to severe hallux valgus was conducted. The 28 feet (70%) were classified as severe deformity (hallux valgus angle (HVA) &gt;= 40°and/or first intermetatarsal angle (IMA) &gt;= 18°). Mean followup was 18.6 months. On the anteroposterior weightbearing radiographs, HVA, IMA, lateral shape of metatarsal head (round sign), tibial sesamoid position, and first metatarsal shortening were measured. On the lateral weightbearing radiographs, inclination angle of first metatarsal was measured. American Orthopaedic Foot &amp; Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS) scores and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the most recent follow-up.Results:   Mean HVA reduced from 39.3° to 12.8°and mean IMA reduced from 18.6° to 8.4° postoperatively. Incidence of positive round sign of metatarsal head reduced from 57.5% to 5%. Tibial sesamoid position improved from 6.7 to 4.7 using Hardy's classification. Average first metatarsal shortening was 2.8mm. Inclination angle did not changed significantly, from 20.5°to 21.1°. Mean AOFAS score improved from 65.3 points to 97.9 points. All SAFE-Q subscores also significantly improved postoperatively. There were 5 complications required surgeries: 2 metatarsal screw removals and 3 bone eminence resections. There were some other complications including 3 under-correction cases and one numbness for at least 6 months.Conclusion:   MICA could improve moderate to severe hallux valgus both radiographically and clinically. Accordingly, our results suggest that this procedure provides an effective means of correcting hallux valgus regardless of severity of deformity.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities