2023 IFFAS Award for Excellence Winner: Percutaneous vs Open Distal Chevron Osteotomy for the Treatment of Hallux Valgus: A Prospective Randomized Study

Category: Bunion: Midfoot/Forefoot Introduction/ Purpose: This study aimed to compare the radiologic and clinical outcomes of percutaneous and open distal chevron osteotomies. Methods: Seventy-one patients with hallux valgus deformity were randomized to undergo percutaneous distal chevron osteotomy (percutaneous group, n = 36) or open distal chevron osteotomy (open group, n = 35). The primary outcome was the hallux valgus angle 12 months postoperatively. The secondary outcomes were other radiographic parameters including inter-metatarsal angle, medial sesamoid position, first metatarsal shortening, and first metatarsal declination angle, and functional outcomes, such as foot and ankle outcome score (FAOS), foot functional index (FFI), pain visual analog scale (VAS), patient satisfaction, shoe restriction, and metatarsophalangeal (MTP) joint range of motion. Radiological and clinical outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively. The VAS for pain was evaluated preoperatively and at 1 day, 2 weeks, 6 weeks, and 3, 6, and 12 months postoperatively. Results: At year 1 post-operation, there were no significant differences between the groups in any radiographic parameters, except the first metatarsal declination angle. The mean first metatarsal declination angle was significantly lower in the open group than that in the percutaneous group. The FAOS, FFI, patient satisfaction, and shoe restriction did not differ significantly between the groups. However, the percutaneous group had a significantly lower VAS score for pain on day 1 post-operation than the open group. The mean range of motion of the first MTP joint decreased significantly only in the open group. Conclusion: Radiological and clinical outcomes following percutaneous distal chevron osteotomy were comparable to those of open distal chevron osteotomy. However, the percutaneous group had an advantage over the open group as it showed a lower immediate postoperative pain level and better range of motion of the first MTP joint.