Minimally invasive retrocapital osteotomy of the first metatarsal in hallux valgus deformity

Objective Percutaneous retrocapital distal osteotomy of the first metatarsal for surgical treatment of hallux valgus. Indications Mild to moderate hallux valgus deformity in both juveniles and adults. Recurrent hallux valgus deformity after previous surgery. Contraindications Severe degenerative changes of the first metatarsophalangeal joint (hallux valgus et rigidus). Previous Keller’s procedure. Surgical Technique A percutaneous distal linear osteotomy of the first metatarsal is performed and stabilized with a Kirschner wire. The surgical technique follows these steps: distal Kirschner wire insertion; skin incision; sparse periosteal detachment; distal retrocapital osteotomy of the first metatarsal; correction of the first intermetatarsal angle by lateral displacement of the capital fragment; stabilization with Kischner wire insertion into the proximal metatarsal; postoperative taping. Results The patients were satisfied following 107 (91%) of 118 consecutive percutaneous procedures with a follow-up of 35.9 months (range 24–78 months). According to the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal- interphalangeal scale for the clinical assessment, a mean score of 88.2 ± 12.9 was obtained at follow- up. The clinical results can be compared to those obtained with open techniques, with the advantages of a minimally invasive procedure.