Background: Hallux valgus (HV) is a common forefoot deformity associated with pain, gait impairment, and reduced quality of life. Minimally invasive chevron-Akin (MICA) osteotomy provides reliable correction with low reported recurrence. However, when combined with distal minimally invasive metatarsal osteotomies (DMMOs) for coexistent metatarsalgia, altered forefoot biomechanics may increase recurrence risk. No prior study has directly compared outcomes between isolated MICA and combined MICA+DMMO. The primary objective was to compare radiographic recurrence at 12 months, with secondary objectives including patient-reported outcomes, pain, and complications. We hypothesized that MICA+DMMO would be associated with higher radiographic recurrence. Methods: This retrospective comparative cohort study included 121 consecutive patients undergoing minimally invasive HV correction at 2 high-volume centres between 2019 and 2024, with a minimum 12-month follow-up. Sixty patients underwent MICA alone and 61 underwent MICA+DMMO (second-fourth metatarsals). Outcomes included radiographic angles (hallux valgus angle HVA, intermetatarsal angle), Patient-Reported Outcomes Measurement Information System PROMIS physical function and pain interference, visual analogue scale (VAS) pain, and complications. Recurrence was defined as HVA >20 degrees. Results: Baseline demographics and deformity severity were comparable between groups. Both cohorts achieved significant early correction. At 12 months, mean HVA was lower following MICA alone (14.9 ± 3.8 degrees) compared with MICA+DMMO (17.7 ± 4.7 degrees; mean difference 2.8 degrees, 95% CI 1.0-4.6; P = .003). Radiographic recurrence occurred in 11.7% of MICA patients vs 47.5% of MICA+DMMO patients (absolute risk difference 35.8%, 95% CI 20.6-50.9; P < .0001). PROMIS physical function improved substantially in both groups, with greater 12-month improvement in the MICA+DMMO cohort (mean change 36.6 vs 29.8 points; mean difference 6.8, 95% CI 4.1-9.5; P < .0001), exceeding minimal clinically important difference thresholds. PROMIS pain interference decreased by more than 30 points in both groups, with no between-group difference. VAS pain improved similarly to a mean of 1.4 at final follow-up. Overall complication rates were comparable (15%). Conclusion: Both isolated MICA and combined MICA+DMMO were associated with radiographic correction and clinically significant improvements in pain and function at 12 months. However, the addition of DMMO is associated with a substantially higher rate of radiographic recurrence at 12 months despite greater functional gains; these findings should be interpreted as short-term observational associations rather than causal evidence. Further prospective studies are warranted to clarify the long-term biomechanical impact of combined procedures. Level of Evidence: Level III, retrospective comparative study.
Genuth et al. (Thu,) studied this question.