scholarly journals Radiologic Recurrence of Hallux Valgus Deformity after Scarf and Akin Osteotomy in Patients with High Distal Metatarsal Articular Angle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0041
Author(s):  
Jae Wan Suh ◽  
Seung-Gwan Park ◽  
Sung Hyun Kim ◽  
Hyun-Woo Park
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Fisher Exact Test ◽  
Hallux Valgus Deformity ◽  
Akin Osteotomy ◽  
Risk Factors For Recurrence

Category: Bunion Introduction/Purpose: The most frequent complication after hallux valgus corrective surgery is recurrence of deformity. Many factors have been identified previously as risk factors for recurrence. Especially, inadequate correction of the distal metatarsal articular angle (DMAA) has been reported one of the surgical risk factors for recurrence. This study aimed to investigate the recurrence rate after hallux valgus correction using Scarf and Akin osteotomy and to identify the significance of postoperative DMAA as a risk factor of recurrence. Methods: We reviewed 87 hallux valgus patients (122 feet) who received Scarf and Akin osteotomy from January 2007 to August 2015. Clinical outcomes were evaluated using VAS and the AOFAS score. Radiological outcome measures included hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) in serial weight bearing radiograph. Recurrence was defined as more than 20 degrees of HVA in final follow-up radiograph. Radiological factors associated with recurrence including high DMAA were evaluated and analyzed. Results: Mean follow-up duration was 20.6 months (range, 12.0-46.5 months) and mean age was 44 years (13-80 years). The VAS and AOFAS scores were significantly improved at the final follow-up (7.0 to 2.0, p<0.001, 78.0 to 92.0, p<0.001). Significant corrections in the HVA, IMA and DMAA were obtained(p<0.001). Eleven (9.0%, 11/122) cases recurred hallux valgus deformity. Postoperative IMA, DMAA and HVA showed significant moderate to strong correlation with HVA at final follow-up (rho: Spearman correlation coefficient, 0.42, 0.71, 0.87, p<0.001). There was no recurrence in cases of postoperative DMAA less than 11.3 degree (fisher exact test, p<0.001). Conclusion: High DMAA is one of numerous risk factor for hallux valgus recurrence after scarf and akin osteotomy. To avoid recurrence, we suggest that surgical correctional goal of DMAA should be considered less than 11.3 degrees.

scholarly journals Does the Presence of Pes Planus Deformity Increase Recurrence of Hallux Valgus Deformity Following Surgery?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0021
Author(s):  
Gavin Heyes ◽  
Eric Swanton ◽  
Lyndon Mason ◽  
Andrew P. Molloy
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
P Value ◽  
X Rays ◽  
Recurrence Rates ◽  
Pes Planus ◽  
Hallux Valgus Deformity ◽  
Increased Risk

Category: Bunion Introduction/Purpose: Factors linked with increased risk of developing Hallux Valgus include; shod footwear, genetic factors, metatarsal morphology, ligamentous laxity and Pes Planus. With regards to Pes planus, it has been suggested that the loss of the medial longitudinal arch in Pes Planus increases Hallux plantar medial pressures and drives deformity during heel rise. There is little in the literature regarding whether Pes Planus is associated with increased recurrence rates. Given this is a potentially modifiable risk factor we believe the risk of recurrence should be studied. This paper reports the results of a retrospective study following up 183 consecutive Hallux valgus cases. The primary objective is to evaluate whether pes planus is associated with increased recurrence following treatment. Methods: Retrospective review of consecutively treated patients from 07/03/2008 to 05/12/2017. Patients were typically followed up for six to twelve months depending on any additional factors that require follow up. X-rays were performed routinely at six weeks, three months and many had x-rays at six and/or 12 months for additional pathology. We examined radiological markers including Sesamoid location (using the Hardy and Clapham Classification), Hallux Valgus Angle (HVA), Intermetatarsal Angle, Meary’s angle and Talonavicular uncovering. 183 cases were reviewed, 12 were excluded due to previously amputated second toes, Hallux Varus, revision surgery and only 6 weeks follow up. This left 171 cases of which 75 had Pes Planus (Meary’s angle < -4°). Results: Table 1 describes the preoperative HVAs we encountered and the correction achieved along with frequencies. Postoperative measurements were taken off weight bearing x-rays. The incidence of recurrent HVA > 15° was significantly higher in those with Meary’s angle < - 4° (Chi-Sq 22.6 P-value 0.000002). Those with a Meary’s angle -20° to -10° had a significantly higher rate of recurrence than ones measuring -10° to -4° (Chi-Sq 9.7 P-value 0.0018 There was no difference in progression of recurrent deformity between those initially corrected to HVA < 15° (Chi-Sq 0.26 P- value 0.61) and those not. Multiple regression analysis revealed there was no meaningful association with sesamoid location or pes planus with recurrence of Hallux Valgus deformity. Conclusion: Our results demonstrate a link between Preoperative Pes Planus deformity and increased recurrence rates of Hallux Valgus deformity following surgery. Consideration of correction of pes planus and appropriate consent of recurrence rates should therefore be undertaken in treatment of hallux valgus in the presence of pes planus

scholarly journals The corrective ability of the double chevron and Akin osteotomies on medial sesamoid position in Hallux Valgus deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Jie Chen ◽  
Eugene Stautberg ◽  
David Spak ◽  
Gregory Schneider ◽  
Vinod Panchbhavi
Keyword(s):  
Hallux Valgus ◽  
Recurrence Rate ◽  
Lateral Displacement ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Observer Agreement ◽  
P Value ◽  
Great Toe ◽  
Hallux Valgus Deformity ◽  
Akin Osteotomy

Category: Bunion Introduction/Purpose: Recurrence of hallux valgus deformity is a common post-operative complication with rates in the literature ranging from 2.7 – 30%. Lateral displacement of the great toe medial sesamoid is correlated with a high recurrence rate, and failure to reduce sesamoid position has been implicated as a risk factor for recurrence due to an uncorrected deforming force. Sesamoid position has been studied in relation with Scarf osteotomy, but not other corrective osteotomies. The goal of this study is to determine the efficacy of the double chevron and Akin osteotomy in reducing the great toe medial sesamoid. Methods: We retrospectively reviewed all patients in the last five years undergoing hallux valgus correction via the double chevron and Akin osteotomy method with pre-operative and post-operative weight bearing radiographs. We measured sesamoid position pre and post-operatively using the Hardy-Clapham (HC) scale of I-VII with V or greater representing a laterally displaced medial sesamoid. We also measured hallux valgus and inter-metatarsal angles. Measurements were made by three authors in orthopedics and one in radiology. We used intra-class correlation coefficient (ICC) to determine inter-observer agreement and establish reliability. With adequate ICC, we could consider the lead author’s measurements as representative of the group. We examined the percent of hallux valgus cases with displaced sesamoids pre-operatively. Next, we determined how many of those cases did we reduce the sesamoids to grade IV or less. Finally, we performed subgroup analysis for pre-operative HC grades V, VI, and VII to determine correction percentage by severity. Results: There were 49 patients with 53 feet treated with the double chevron and Akin osteotomies for hallux valgus correction. Of these, 39 (73.6%) had significant preoperative lateral displacement of the medial sesamoid characterized by HC grade of V or greater. We corrected 30/39 (77.0%) to a reduced position of HC grade IV or less (p-value 0.048). In sub-analysis, we achieved reduction of the medial sesamoid position in 14/14 feet (100%) with HC grade V, 6/9 feet (66.7%) with HC grade VI, and 10/16 feet (62.5%) with HC grade VII (p-value 0.037). The ICC was 0.91 for pre-operative HC scores and 0.79 for post-operative HC scores. Average pre and post-operative HVA was 29.4° and 8.7°, respectively. Average pre and post-operative IMA was 13° and 5.2° respectively. Conclusion: Our study validates the double chevron and Akin osteotomies as effective in correcting sesamoid position. We achieved correction in 30/39 (77%) cases with initial sesamoid displacement. For mild cases of displacement with HC grade V, sesamoid correction was always achieved, and we were likely to achieve correction in the more severe cases of sesamoid displacement with HC grade VI or VII as well. The technique is also effective at reducing HVA and IMA. We had acceptable inter- observer agreement which supports the reliability of our methods. Future studies should examine recurrence rate following the double chevron and Akin osteotomies prospectively.

scholarly journals Radiographic Measurements Associated with the Natural Progression of the Hallux Valgus Deformity during at Least Two Years of Follow-up

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002 ◽  
Author(s):  
Kyoung Min Lee ◽  
Seung Yeol Lee ◽  
Sonya Ahmed ◽  
Byung Chae Cho ◽  
Moon Seok Park ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Binary Logistic Regression ◽  
Valgus Deformity ◽  
Binary Logistic Regression Analysis ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Radiographic Measurements

Category: Bunion Introduction/Purpose: There have been few longitudinal studies regarding hallux valgus deformity. This retrospective study aimed to investigate the radiographic measurements associated with the progression of hallux valgus deformity during at least two years of follow-up. Methods: Seventy adult patients (mean age, 58.0 years; standard deviation [SD], 12.3 years; 13 males and 57 females) with hallux valgus who were followed-up for at least two years and underwent weight-bearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Progression of hallux valgus deformity was defined as an increase of 5 degrees or more in the HVA during follow-up. Patients were divided into progressive and non-progressive groups. Binary logistic regression analysis was performed to identify factors that significantly affect the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. Results: Eighteen out of 70 patients showed progression of 5 degrees or more in the HVA during the mean follow-up of 47.0 months (SD, 19.8 months). The DMAA (p=0.027) and AP talo-first metatarsal angle (p=0.034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA (r=0.423; p=0.001) and DMAA (r=0.541; p<0.001). Conclusion: Special attention needs to be given to patients with pes planovalgus and increased DMAA during follow-up. Change in HVA was significantly correlated with changes in IMA and DMAA. Therefore, progression of hallux valgus deformity is considered to be closely related to the progressive instability of the first tarsometatarsal joint.

scholarly journals Early Clinical Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight Bearing

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039
Author(s):  
Justin Ray ◽  
Jennifer Koay ◽  
Robert Santrock
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Recurrence Rates ◽  
Full Activity ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Athletic Shoes

Category: Bunion Introduction/Purpose: There are numerous corrective procedures for hallux valgus deformity. The majority of procedures prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. Long-term results demonstrate high recurrence rates ranging from 8-78% with various metatarsal osteotomy techniques. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. Correction of hallux valgus at the first tarsometatarsal joint (modified Lapidus) offers a powerful method to restore anatomic alignment in all three planes and correct hallux valgus at the apex of the deformity. The purpose of this study is to investigate early clinical and radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, charts and radiographs were retrospectively reviewed for 37 patients (30 female, age 54.8 years) undergoing triplanar tarsometatarsal (TMT) arthrodesis for hallux valgus deformity correction at our institution between June 2016 and June 2017. All patients were allowed immediate weight-bearing as tolerated in a boot walker. Radiographic imaging at 4 months and 12 months was compared to pre-operative imaging. Clinical outcomes were evaluated using the American Academy of Orthopaedic Surgeons Foot and Ankle questionnaire (AAOS FAQ), Quality of Life 12 (QOL-12), and the patient-reported outcomes measurement information system 10 (PROMIS 10). Demographics included age, gender, body mass index, and medical comorbidities. The time in days to weight-bearing, wearing athletic shoes, and return to full activity were noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Although improvements were noted in the AAOS FAQ and PROMIS 10 at 3 and 6 months post-operative, these results were not significantly different compared to baseline scores (Table 1). From the time of procedure, average time to weight-bearing was 2.75 ± 7.2 days. Patients returned to wearing athletic shoes an average of 48.3 ± 12.1 days after the procedure. Return to full activity without restrictions was 130.9 ± 37.0 days from surgery. Radiographic results demonstrated significant improvement in IMA and HVA at final follow-up (p < 0.001). 35 patients (94.6%) demonstrated evidence of radiographic union by final follow-up. Regarding complications, one patient (2.7%) required hardware removal for soft-tissue irritation, and there were three cases (8.1%) of hardware failure that did not require re-operation. Conclusion: In this study, early clinical and radiographic outcomes of triplanar tarsometatarsal corrective arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. Patients were able to return to normal shoe wear approximately 7 weeks after the procedure and return to full activity a little more than 4 months after surgery. Radiographic results demonstrated high union rates, low recurrence rates, and significant improvements in HVA and IMA at final follow-up. Longer follow-up is necessary to determine the long-term radiographic and clinical outcomes of triplanar tarsometatarsal arthrodesis to correct hallux valgus deformity.

scholarly journals Multicenter Early Radiographic Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight-Bearing

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
Justin Ray ◽  
Jennifer Koay ◽  
Paul Dayton ◽  
Daniel Hatch ◽  
W. Bret Smith ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Transverse Plane ◽  
Categorical Variables ◽  
Recurrence Rates ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity

Category: Bunion Introduction/Purpose: Hallux valgus is a complex positional deformity of the first ray. Traditional correction methods for hallux valgus prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. However, only addressing the transverse plane component of hallux valgus is a potential factor resulting in poor outcomes and high long-term recurrence rates ranging from 8%-78%. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. The triplanar tarsometatarsal arthrodesis (modified Lapidus, Figure 1) uses a multi-planar approach to evaluate and correct the deformity associated with hallux valgus in all three anatomical planes. The purpose of this study is to investigate early radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, radiographs and charts were retrospectively reviewed for 101 patients (age 41.9 ± 17.9 years) undergoing triplanar tarsometatarsal arthrodesis (modified Lapidus) for hallux valgus deformity correction at four institutions between June 2016 and June 2017. Patients were allowed immediate weight-bearing as tolerated after the procedure. Radiographic imaging at 4 months and 12 months was reviewed and compared to pre-operative imaging. Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), metatarsus adductus angle, evidence of metatarsal pronation, and radiographic first TMT union. Demographics included age, gender, body mass index, medical comorbidities, and smoking status. Time (days) to weight-bearing, wearing athletic shoes, and return to full activity were also noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Radiographic results demonstrated significant improvements in IMA, HVA, and TSP at final follow-up. IMA was 5.9 ± 3.2 degrees at final follow-up compared to 15.0 ± 3.1 degrees pre-operatively (p < 0.001). At final follow-up, HVA was 8.3 ± 5.5 degrees compared to 23.7 ± 10.1 degrees pre-operatively (p < 0.001). TSP was also significantly improved at final follow-up (2.0 ± 0.9) compared to pre-operatively (5.1 ± 1.2; p < 0.001). Lateral round sign was present in 5 patients (4.9%) at final follow-up compared to 88 patients (87.1%) prior to corrective surgery. Four patients (4.0%) demonstrated evidence of radiographic non-union at final follow-up. Regarding complications, there were four cases (3.9%) of hardware removal for either soft-tissue irritation or hardware failure. Conclusion: In this study, early radiographic outcomes of triplanar tarsometatarsal arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. These results demonstrate that this procedure is able to reliably achieve anatomic correction in all three planes for hallux valgus deformity. The triplanar tarsometatarsal arthrodesis technique also demonstrated high union rates and low recurrence rates at final follow-up. Longer follow-up is necessary to determine the long-term survivorship, outcomes, and complications of this new technique to correct hallux valgus deformity.

scholarly journals Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity

2021 ◽  
Vol 18 (19) ◽  
pp. 10473
Author(s):  
Yuki Etani ◽  
Makoto Hirao ◽  
Kosuke Ebina ◽  
Takaaki Noguchi ◽  
Gensuke Okamura ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Surgical Procedures ◽  
Weight Bearing ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Great Toe ◽  
Forefoot Deformity ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity

With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.

scholarly journals Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis

2021 ◽  
Vol 18 (20) ◽  
pp. 10667
Author(s):  
Takumi Matsumoto ◽  
Yuji Maenohara ◽  
Song Ho Chang ◽  
Kumiko Ono ◽  
Yasunori Omata ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Soft Tissue ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Soft Tissue Release ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
Patient Reported ◽  
Akin Osteotomy

Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.

scholarly journals A Novel Technique for Moderate Hallux Valgus Correction: The BC Osteotomy

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Gaston Slullitel ◽  
Juan Pablo Calvi ◽  
Victoria Alvarez ◽  
Laura Gaitan ◽  
Valeria Lopez
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Invasive Technique ◽  
First Metatarsophalangeal Joint ◽  
Hallux Valgus Deformity ◽  
Surgical Methods ◽  
The Mean

Category: Bunion Introduction/Purpose: Surgical correction of hallux valgus rebalances the first ray, correcting the various features of the deformity. While several surgical methods are available, consensus regarding the best management has yet to be established. In the last decades, there was an increasing interest in mini-invasive procedures. In this scenario the Bosch technique appears to be a reproducible DMO to achieve proper correction. Theoretically, it allows for fast and safe correction of the deformity, however it was criticized for its unstable nature. We describe a new distal metatarsal osteotomy (DMO) that it is a combination of the (traditional) chevron and the (mini-invasive) Bosch-SERI techniques. The purpose of this investigation is to describe the surgical technique and report the results of this modified procedure at a minimum 2-year follow-up. Methods: Between January 2016 and June 2018, 63 consecutive patients, with mild to moderate hallux valgus deformity underwent corrective surgery using the BC technique. Preoperatively, each patient’s data was recorded and all patients underwent an assessment of functional limitation and pain level as well as a physical examination that included measurement of the passive range of motion of the first metatarsophalangeal joint. At final follow up, the patients were assessed using the American Orthopaedic Foot & Ankle Society’s (AOFAS) hallux- metatarsophalangeal and interphalangeal scale. Additionally, patients were asked to rate their satisfaction with regard to the overall result of the operation according to the Coughlin overall satisfaction scale. Anteroposterior and lateral weight-bearing radiographs were made preoperatively as well as at the short-term and intermediate-term follow-up evaluations. The HVA, the first IMA, and the congruency of the first metatarsophalangeal joint were measured with the technique recommended by the AOFAS. Results: BC osteotomy was performed in 62 patients, including 33 right feet and 29 left feet, with no bilateral procedures. The patient population consisted of 50 females (79%), with an average age of 50.4 years (range 19 to 75) years. The mean follow-up time was 36.5 months (range 23 to 59). The mean AOFAS score improved from 69.3 preoperatively to 88 postoperatively (p<0.001). IMA and HVA pre and postoperative improved from a median of 30.7 degrees to 11.1 degrees for HVA and 13.9 degrees to 6.5 degrees for the IMA (p<0.001). 82.5% of patients were very satisfied / satisfied with the procedure. There were no cases of infection, however we observed two cases of complex regional pain syndrome and two screws that required removal. Conclusion: We believe this osteotomy has a number of advantages: (1) one mini-invasive approach is used; (2) a large correction can be obtained in all directions including the frontal and sagittal planes; (3) blood supply to the metatarsal head is preserved; and (4) intrinsically stable OT, allowing immediate full weight bearing. The merge, of percutaneous techniques and classic stable fixed approach may seems to offer a stable, effective and reproducible correction of hallux valgus deformity with the advantages of a minimally-invasive technique

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