Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus

Background: Recurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described. Methods: 32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%). Results: Patients were assessed with a mean follow-up of 9.8 ± 4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9 ± 17.8 points to 85.2 ± 14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1 ± 9.1 to 9.7 ± 5.4°, the intermetatarsal angle decreased from 11.5 ± 4.5 to 6.7 ± 4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case). Conclusions: Percutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery. Levels of evidence:: IV, Retrospective Case Series.