Comparison of Proximal and Distal Osteotomy in Minimally Invasive Hallux Valgus Surgery: A Retrospective Cohort Study

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Minimally invasive surgery (MIS) for hallux valgus has gained popularity due to various advantages, including smaller incisions and the potential for reduced soft tissue trauma. However, distal osteotomy has been widely studied among MIS techniques, whereas reports on proximal osteotomy remain limited. This study aimed to compare the outcomes of proximal and distal osteotomy, focusing on the effectiveness of proximal osteotomy in severe hallux valgus cases. Methods: A retrospective cohort study was conducted on patients who underwent MIS for hallux valgus between February 2021 and January 2023. Surgical technique selection was based on deformity severity: proximal osteotomy for severe cases and distal osteotomy for moderate to mild deformities. Patient demographics, recurrence rates, and complications were documented. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). At the same time, radiographic evaluation included intermetatarsal angle (IMA) and hallux valgus angle (HVA) in patients followed for at least two years postoperatively. Results: A total of 43 patients underwent MIS for hallux valgus (proximal: 21, distal: 22). Both groups showed significant FAOS improvements across all subscales, with no statistically significant differences (p>0.05). Radiographic analysis confirmed substantial IMA and HVA correction. The proximal group’s IMA improved from 16.02° to 7.4°, stabilizing at 9.1° at two years, while the distal group’s IMA decreased from 14.69° to 6.0°, maintaining 7.6°. Similarly, HVA improved from 34.12° to 13.38°, reaching 17.55° (proximal) and from 31.2° to 8.28°, stabilizing at 12.56° (distal). No significant differences were found in IMA and HVA correction (p=0.25, p=0.38). Complication rates were comparable (proximal: 14.3%, distal: 13.6%; p=0.92), and recurrence was observed in two patients per group (p=0.88) Conclusion: Conclusion Both proximal and distal osteotomies yielded significant clinical and radiographic improvements at the two-year follow-up. Recurrence and complication rates were similar between the two techniques, suggesting that proximal osteotomy remains a viable option, particularly for severe hallux valgus cases. Two years after minimally invasive proximal osteotomy