International Orthopaedics

, Volume 42, Issue 1, pp 117–124 | Cite as

Percutaneous minimally invasive Akin osteotomy in hallux valgus interphalangeus: a case series

  • Gerhard KaufmannEmail author
  • Martin Handle
  • Michael Liebensteiner
  • Matthias Braito
  • Dietmar Dammerer
Original Paper



Phalangeal Akin osteotomy of the greater toe is a frequently used surgical procedure for correcting hallux valgus interphalangeus deformity. However, previous research did not investigate percutaneous techniques of the Akin osteotomy. It was the aim of this study to investigate feasibility, corrective potential, and safety of a percutaneous minimally invasive Akin osteotomy.


We present a series of 81 feet, in which a percutaneous Akin technique was performed using a high-speed burr but no fixation device. The most important outcome parameters were determined as the proximal to distal phalangeal articular angle (PDPAA) (corrective effect of the osteotomy), the osteotomy healing (full, partly, no visibility of the osteotomy gap), and the integrity of the lateral cortical hinge.


With regard to the main hypothesis we found significant changes in the PDPAA over the whole period of time (p < 0.001). Post-hoc tests determined that the PDPAA changed from 10° pre-operatively (Md, IQR 4.3) to 2.3° post-operatively (Md, IQR 3.7) (p < 0.001). Post-operatively no significant changes in PDPAA were found within the first six weeks and from six weeks to three months (no loss of correction). Osteotomy healing was satisfactory as well. Three months post-operatively, there were no patients with a fully visible osteotomy gap, 28.3% with a partly visible osteotomy gap, and 71.7% had no visible gap. Interestingly, we could not observe a statistically significant correlation between bone healing and the integrity of the lateral cortical hinge.


From our findings we conclude that the minimally invasive Akin osteotomy without osseous fixation provides effective deformity correction without significant loss of correction thereafter. This procedure appears to be safe with regard to osseous healing. Surprisingly, the healing process of the osteotomy showed no dependence on the integrity of the lateral cortical hinge.

Levels of Evidence: Therapeutic, Level IV, retrospective case series.


Hallux valgus interphalangeus Akin osteotomy Minimally invasive Phalangeal Percutaneous 



The authors would like to thank Mrs. Margreiter M. for translational correction of this manuscript.


There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was not required due to the retrospective study design of a radiological analysis.


  1. 1.
    Al-Nammari SS, Christofi T, Clark C (2015) Double first metatarsal and Akin osteotomy for severe hallux valgus. Foot Ankle Int 36:1215–1222.
  2. 2.
    Rettedal D, Lowery NJ (2014) Proximal phalangeal osteotomies for hallux abductovalgus deformity. Clin Podiatr Med Surg 31:213–220. CrossRefPubMedGoogle Scholar
  3. 3.
    Cohen MM (2003) The oblique proximal phalangeal osteotomy in the correction of hallux valgus. J Foot Ankle Surg 42:282–289CrossRefPubMedGoogle Scholar
  4. 4.
    Springer KR (1989) The role of the akin osteotomy in the surgical management of hallux abducto valgus. Clin Podiatr Med Surg 6:115–131PubMedGoogle Scholar
  5. 5.
    Vander Griend R (2017) Correction of hallux valgus Interphalangeus with an osteotomy of the distal end of the proximal phalanx (distal Akin osteotomy). Foot Ankle Int 38:153–158. CrossRefPubMedGoogle Scholar
  6. 6.
    Roy SP, Tan KJ (2013) A modified suture technique for fixation of the Akin osteotomy. J Foot Ankle Surg 52:276–278. CrossRefPubMedGoogle Scholar
  7. 7.
    Levitsky DR, DiGilio J, Kander R, Rubin B (1982) Rigid compression screw fixation of first proximal phalanx osteotomy for hallux abducto valgus. J Foot Surg Spring 21:65–69Google Scholar
  8. 8.
    Neumann JA, Reay KD, Bradley KE, Parekh SG (2015) Staple fixation for akin proximal phalangeal osteotomy in the treatment of hallux valgus interphalangeus. Foot Ankle Int 36:457–464. CrossRefPubMedGoogle Scholar
  9. 9.
    Chacon Y, Fallat LM, Dau N, Bir C (2012) Biomechanical comparison of internal fixation techniques for the akin osteotomy of the proximal phalanx. J Foot Ankle Surg 51:561–565. CrossRefPubMedGoogle Scholar
  10. 10.
    Biz C, Fosser M, Dalmau-Pastor M, Corradin M, Rodà MG, Aldegheri R, Ruggieri P (2016) Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up. J Orthop Surg Res 11:157. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kurashige T, Suzuki S (2016) Effectiveness of percutaneous proximal closing wedge osteotomy with akin osteotomy to correct severe hallux valgus determined by radiographic parameters: a 22-month follow-up. Foot Ankle Spec 10:170–179. CrossRefPubMedGoogle Scholar
  12. 12.
    Redfern D, Vernois J, Legré BP (2015) Percutaneous surgery of the forefoot. Clin Podiatr Med Surg 32:291–332. CrossRefPubMedGoogle Scholar
  13. 13.
    Dixon AE, Lee LC, Charlton TP, Thordarson DB (2015) Increased incidence and severity of postoperative radiographic hallux valgus interphalangeus with surgical correction of hallux valgus. Foot Ankle Int 36:961–968. CrossRefPubMedGoogle Scholar
  14. 14.
    Jung HG, Kim TH, Park JT, Shin MH, Lee SH (2014) Proximal reverse chevron metatarsal osteotomy, lateral soft tissue release, and akin osteotomy through a single medial incision for hallux valgus. Foot Ankle Int 35:368–373. CrossRefPubMedGoogle Scholar
  15. 15.
    Tóth K, Kellermann P, Wellinger K (2010) Fixation of Akin osteotomy for hallux abductus with absorbable suture. Arch Orthop Trauma Surg 130:1257–1261. CrossRefPubMedGoogle Scholar
  16. 16.
    Cullen NP, Angel J, Singh D, Burg A, Dudkiewicz I (2009) Fixation of an Akin osteotomy with a tension suture: our results. Foot (Edinb) 19:107–109. CrossRefGoogle Scholar
  17. 17.
    Castillo-Lopez JM, Ramos-Ortega J, Reina-Bueno M, Domínguez-Maldonado G, Palomo-Toucedo IC, Munuera PV (2014) Hallux abductus interphalangeus in normal feet, early-stage hallux limitus, and hallux valgus. J Am Podiatr Med Assoc 104:169–173. CrossRefPubMedGoogle Scholar
  18. 18.
    Bucito R (2014) Prospective randomized study of chevron osteotomy versus Mitchell’s osteotomy in hallux valgus. Foot Ankle Int 35:1268–1276. CrossRefGoogle Scholar
  19. 19.
    Bock P, Kluger R, Kristen KH, Mittelböck M, Schuh R, Trnka HJ (2015) The scarf osteotomy with minimally invasive lateral release for treatment of hallux valgus deformity: intermediate and long-term results. J Bone Joint Surg Am 97:1238–1245. CrossRefPubMedGoogle Scholar
  20. 20.
    Milczarek MA, Milczarek JJ, Tomasik B, Łaganowski P, Nowak K, Domżalski M (2017) Being overweight has limited effect on SCARF osteotomy outcome for hallux valgus correction. Int Orthop 41:765–772. CrossRefPubMedGoogle Scholar
  21. 21.
    Willegger M, Holinka J, Ristl R, Wanivenhaus AH, Windhager R, Schuh R (2015) Correction power and complications of first tarsometatarsal joint arthrodesis for hallux valgus deformity. Int Orthop 39:467–476. CrossRefPubMedGoogle Scholar
  22. 22.
    Andrews BJ, Fallat LM, Kish JP (2016) Screw versus plate fixation for chevron osteotomy: a retrospective study. J Foot Ankle Surg 55:81–84. CrossRefPubMedGoogle Scholar
  23. 23.
    Faldini C, Nanni M, Traina F, Fabbri D, Borghi R, Giannini S (2016) Surgical treatment of hallux valgus associated with flexible flatfoot during growing age. Int Orthop 40:737–743. CrossRefPubMedGoogle Scholar
  24. 24.
    Corrales LA, Morshed S, Bhandari M, Miclau T (2008) Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am 90:1862–1868. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Dijkman BG, Sprague S, Schemitsch EH, Bhandari M (2010) When is a fracture healed? Radiographic and clinical criteria revisited. J Orthop Trauma 1:S76–S80. CrossRefGoogle Scholar
  26. 26.
    Morshed S, Corrales L, Genant H, Miclau T (2008) Outcome assessment in clinical trials of fracture-healing. J Bone Joint Surg Am 1:62–67. CrossRefGoogle Scholar
  27. 27.
    Summers NJ, Ashcraft J, Badri H, Mostafa J, Barrett B, Sganga M, Cook JJ, Basile P, Cook EA (2015) Development of a radiographic union score for determining Osteotomy union rates in long bones of the foot. J Foot Ankle Surg 54:793–797. CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.OFZ InnsbruckInnsbruckAustria
  2. 2.Orthopaedic DepartmentMedical University of InnsbruckInnsbruckAustria

Personalised recommendations