Efficacy of Minimally Invasive Surgical Techniques on Hallux Valgus: A Systematic Review

Abstract

Introduction: Hallux valgus is a deformity of the first ray and is one of the most common foot deformities that requires surgery. More than 130 procedures have been described in the literature, all with varying degrees of success. Most of these procedures are performed by open incision. However, the evolution of minimal incision surgery has led to some of these procedures being performed minimally invasively, with no definitive consensus on which technique is more effective. The aim of this study was to systematically search the literature in order to evaluate the efficacy of minimally invasive surgery (MIS) for hallux valgus with respect to surgical outcomes and patient reported outcomes.

Methods: Medline Complete, PubMed, Cochrane Library, Scopus, SAGE Journals and gray literature were searched. All studies published in English documenting surgical outcomes and patient reported outcomes were included.

Results: The literature search identified 2,558 abstracts which were screened for eligibility and 30 papers were identified as meeting the inclusion criteria. A total of 1,979 patients were treated over all included studies. The surgical outcome measures reported by most papers included hallux valgus angle, distal metatarsal articular angle, and intermetatarsal articular angle. Patient reported outcome measures reported included the American Orthopaedic Foot and Ankle Society Score, pain on a visual analogue scale and subjective patient satisfaction. All complications reported were extracted. Follow up times ranged from 5 months to 10 years, with most papers reporting 12-24 months.

Conclusion: This review demonstrates the wide variety of procedures for hallux valgus. Overall, there is no sufficient data to suggest that one minimally invasive procedure is superior to another. We note that a larger number of studies reporting MICA and Reverdin-Isham procedures were present in the literature and the higher complication rate in the Reverdin-Isham compared to MICA. More controlled trials are necessary to further explore patient preference with each procedure, in particular with regard to longer term patient reported outcomes.