Outcomes of Minimally Invasive Surgery versus Traditional Open Surgery in Managing Forefoot Deformities: A Retrospective Cohort Study in Saudi Arabia

Abstract Background: Patients with hallux valgus with hammer toes have limited mobility and quality of life. In Saudi Arabia, 21% of individuals have hallux valgus, which often requires surgery. Minimally invasive surgery (MIS) is becoming more popular because of its reduced post-operative discomfort, quicker recovery and superior cosmetic results. Despite its expanding popularity, MIS is underreported locally for foot abnormality patients, underlining the need for regional statistics to aid surgical decision-making. There is little research on this in Saudi Arabia, especially Al-Ahsa. Methods: From January 2017 to December 2021, three Al-Ahsa tertiary care facilities performed MIS or open surgery on 18-year-olds with hallux valgus or hammer toes. We gathered demographics, comorbidities, perioperative data, complications and outcomes including surgical time, hospitalisation length, infection and complication rate, weight-bearing time and pain scores. Results: A total of 210 patients were retrospectively evaluated (105 MIS; 105 open surgery). Groups were similar in age ( P > 0.05). The average hospital stay for MIS and open surgery patients was 2.1 ± 1.0 and 3.4 ± 1.2 days, respectively ( P < 0.001). The MIS group recovered faster (median: 2 weeks vs. 4 weeks; P < 0.05). Although there was no significant difference in infection rates between groups (P = 0.33), the MIS group experienced fewer wound problems ( P < 0.05). Malalignment and recurrence rates were comparable between groups at 12 months ( P = 0.81). Conclusion: MIS provides faster recovery and shorter hospitalisation without increasing post-operative complications. It is an effective treatment option for forefoot deformities. Prospective multicentre studies are recommended.