A comparative study of distal chevron osteotomy and minimally invasive surgery for surgical correction of hallux valgus deformity

Hallux valgus is a common forefoot deformity that significantly impacts patients’ functional status and quality of life. This study aims to compare the mid-term clinical and radiographic outcomes of DCMO and MIS in hallux valgus correction. A retrospective cohort study for 60 patients (34 DCMO, 26 MIS) was analyzed. Clinical outcomes were evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ) and Foot Function Index (FFI), while radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and sesamoid position were assessed preoperatively and at the final follow-up. Statistical comparisons were performed using t-tests, Mann-Whitney U tests, and chi-square tests, with significance set at p < 0.05. The DCMO group demonstrated superior clinical outcomes, with significantly better MOXFQ pain sub-scale ( p < 0.001) and index scores ( p = 0.002). However, although the between-group difference in pain-related outcomes was statistically significant, it did not reach the minimal clinically important difference (MCID), indicating that the clinical relevance of this advantage may be limited. The improvement in FFI scores was also significantly greater in the DCMO group ( p = 0.022). In contrast, the MIS group exhibited superior radiographic correction, with significantly greater improvements in HVA ( p = 0.027), IMA ( p = 0.001), and sesamoid displacement ( p = 0.001). First metatarsal shortening was more pronounced in the MIS group, showing a trend towards statistical significance ( p = 0.050). Postoperative complications were comparable, with recurrence rates of 8.8% (DCMO) and 7.6% (MIS). DCMO showed statistically superior patient-reported outcomes, although its pain-related benefit did not exceed the MCID. MIS achieved greater radiographic correction. Procedure selection should be individualized according to patient-specific factors, radiographic goals, and surgeon expertise. In addition, surgeons transitioning to MIS should be aware of the potential risk of frictional heat-related soft tissue injury and should use meticulous fluoroscopic guidance, controlled instrumentation, and adequate irrigation to minimize this complication.