Hallux Valgus Surgery: The Minimally Invasive Bunion Correction

Abstract

The main goal of surgical correction of hallux valgus is the morphologic and functional rebalance of the first ray, correcting all other characteristics of the deformity.¹ Histo-rically, distal metatarsal osteotomies have been indicted in cases of mild or moderate deformity with an intermetatarsal angle as large as 15°. Using certain osteotomies, it is possible to correct intermetatarsal angles as large as 20°. Distal osteotomies may also be used to correct deformities characterized by deviation of the distal metatarsal articular angle (DMAA) or to address concomitant stiffness.² Since the first operation published by Revenrdin³ in 1881, many authors have reported their experience using different operations, each of them characterized by different indications, approaches, designs, and fixation.^4–12 Several comparative studies have been reported comparing radiographic and clinical results among many different techniques, and a review of the literature reveals the satisfaction with all operations to be in the upper 80% level or higher.^{2, 13} In 1983, New (personal communication) reported a percutaneous technique for hallux valgus correction. This technique was then reported by Bosh et al.,¹⁴ who perform a Hohmann-type⁴ osteotomy fixed by only one K-wire, as described by Lamprecht and Kramer¹⁵ in 1982, and, more recently, Magnan et al.¹⁶ reported a description of his experience. These percutaneous operations reduce the surgical trauma because they are performed without large incisions and soft tissue procedures. They require, on the other hand, the use of particular instrumentation, such as Lindemann’s osteotrite, manipulators, or dislocators. Furthermore, with these percutaneous techniques, the correction is performed blindly, and the intraoperative use of fluoroscopy is needed. The minimally invasive bunion correction used by us is not a new technique^17,18 because it uses an osteotomy and a stabilization method already reported by other authors, making the surgical technique usable in accordance with current concepts in hallux valgus surgery.