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A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones


  • Ezequiel Palmanovich Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Nissim Ohana Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Omer Slevin Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Viktor Feldman Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Yaron S Brin Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Meir Nyska Sackler Faculty of Medicine, Tel Aviv University
  • David Segal Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel


Background: Current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents correcting the rotational metatarsal head deformity and reduction of sesamoid bones. We aimed to determine the optimal method for sesamoid bone reduction in HV surgery.

Methods: We reviewed the records of 53 patients who underwent HV surgery by a single surgeon from 2017 to 2019 according to one of three techniques: open chevron osteotomy (n=19), minimally invasive V-shaped osteotomy (n=18) and a modified, straight minimally invasive osteotomy (n=16). Sesamoid position was graded using the Hardy and Clapham method based on standing radiographs.

Results: Postoperative sesamoid position scores were significantly lower (better) following the modified osteotomy than following open chevron osteotomy and V-shaped osteotomy (1.44±0.81, 3.74±1.48 and 4.61±1.09, respectively, P<0.001); and the mean change in score was greater (P<0.001).

Conclusion: Modified minimally invasive osteotomy was superior to the two other techniques, in the correction of HV deformity in all planes, including sesamoid reduction.


hallux valgus, distal metatarsal osteotomy, minimally invasive chevron and akin


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De Prado M. Minimally invasive foot surgery: A paradigm shift. Minim. Invasive Surg. Foot Ankle. Springer London; 2011. p. 3–11.

Ferrari J, Higgins JPT, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane database Syst. Rev. [Internet]. 2004 [cited 2020 Mar 11];CD000964. Available from:

Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev. British Editorial Society of Bone and Joint Surgery; 2016;1:295–302.

Palmanovich E, Myerson MS. Correction of moderate and severe hallux valgus deformity with a distal metatarsal osteotomy using an intramedullary plate [Internet]. Foot Ankle Clin. W.B. Saunders; 2014 [cited 2020 Mar 11]. p. 191–201. Available from:

Maffulli N, Longo UG, Marinozzi A, Denaro V. Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review. Br. Med. Bull. [Internet]. 2011 [cited 2020 Mar 11];97:149–67. Available from:

Giannini S, Bevoni R, Vannini F, Cadossi M. Hallux Valgus Surgery: The Minimally Invasive Bunion Correction. Minim. Invasive Surg. Orthop. Springer New York; 2010. p. 463–71.

Magnan B, Pezzè L, Rossi N, Bartolozzi P. Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J. Bone Jt. Surg. - Ser. A [Internet]. 2005 [cited 2020 Mar 11];87:1191–9. Available from:

Malagelada F, Sahirad C, Dalmau-Pastor M, Vega J, Bhumbra R, Manzanares-Céspedes MC, et al. Minimally invasive surgery for hallux valgus: a systematic review of current surgical techniques. [Internet]. Int. Orthop. Springer Verlag; 2019 [cited 2020 Mar 11]. p. 625–37. Available from:

Vernois J, Redfern DJ. Percutaneous Surgery for Severe Hallux Valgus [Internet]. Foot Ankle Clin. W.B. Saunders; 2016 [cited 2020 Mar 11]. p. 479–93. Available from:

Deenik AR, De Visser E, Louwerens JWK, Malefijt MDW, Draijer FF, De Bie RA. Hallux valgus angle as main predictor for correction of hallux valgus. BMC Musculoskelet. Disord. 2008;9.

Okuda R, Kinoshita M, Yasuda T, Jotoku T, Shima H, Takamura M. Hallux valgus angle as a predictor of recurrence following proximal metatarsal osteotomy. J. Orthop. Sci. [Internet]. Springer Tokyo; 2011 [cited 2020 Mar 11];16:760–4. Available from:

Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J. Bone Jt. Surg. - Ser. A [Internet]. Journal of Bone and Joint Surgery Inc.; 2009 [cited 2020 Mar 11];91:1637–45. Available from:

Katsui R, Samoto N, Taniguchi A, Akahane M, Isomoto S, Sugimoto K, et al. Relationship between Displacement and Degenerative Changes of the Sesamoids in Hallux Valgus. Foot Ankle Int. [Internet]. SAGE Publications Inc.; 2016 [cited 2020 Mar 11];37:1303–9. Available from:

Suzuki J, Tanaka Y, Takaoka T, Kadono K, Takakura Y. Axial radiographic evaluation in hallux valgus: evaluation of the transverse arch in the forefoot. J. Orthop. Sci. [Internet]. Springer Japan; 2004 [cited 2020 Mar 11];9:446–51. Available from:

Nyska M. Principles of first metatarsal osteotomies. Foot Ankle Clin. [Internet]. 2001 [cited 2020 Mar 11];6:399–408. Available from:

Hardy RH, Clapham JCR. OBSERVATIONS ON HALLUX VALGUS. J. Bone Joint Surg. Br. [Internet]. 1951 [cited 2020 Mar 11];33-B:376–91. Available from:

Wagner P, Ortiz C, Wagner E. Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases. Tech. foot ankle Surg. [Internet]. Lippincott Williams and Wilkins; 2017 [cited 2020 Mar 11];16:3–10. Available from:

Nyska M, Trnka H-J, Parks BG, Myerson MS. The Ludloff metatarsal osteotomy: guidelines for optimal correction based on a geometric analysis conducted on a sawbone model. Foot ankle Int. [Internet]. 2003 [cited 2020 Mar 11];24:34–9. Available from:

Okuda R. Proximal Supination Osteotomy of the First Metatarsal for Hallux Valgus [Internet]. Foot Ankle Clin. W.B. Saunders; 2018 [cited 2020 Mar 11]. p. 257–69. Available from:

Frigg A, Zaugg S, Maquieira G, Pellegrino A. Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures. Foot Ankle Int. [Internet]. SAGE Publications Inc.; 2019 [cited 2020 Mar 11];40:515–25. Available from: