Is There a “Sweet Spot” for Minimally Invasive Osteotomy Position for Hallux Valgus?

A recent study online ahead of print in Foot and Ankle Specialist examined key anatomic points during MIS bunion surgery in order to evaluate ideal landmarks and positioning. Three surgeons from 2 centers performed surgery on 211 included patients. Retrospective radiographic measurements of these patients, along with cadaveric dissection confirmed preservation and safety of nearby anatomic structures.

The researchers found that a “sweet spot,” averaging 2.2 cm proximal to the first MTPJ was an optimal location for transverse osteotomy. They found that this location led to no harm to tendinous and neurovascular structures while keeping the osteotomy extracapsular. In the cases examined, the authors noted a reduction in tibial sesamoid position by 3 points and an average reduction in first intermetatarsal angle of 10.7 degrees.

To conclude, the authors propose this “MIS Sweet Spot” could contribute to enhanced reproducibility of the procedure and lessen the often-cited learning curve for such approaches. They also contend that this predictable measurement could enhance surgeon confidence, possibly leading to reduced operative times and improved overall results.

Noman Siddiqui, DPM, MHA, FACFAS, one of the authors of the study says he and his coauthors were driven to investigate this concept due to a collective positive experience with the surgical method, including a lack of non-unions.

“Given the high number of cases completed by the coauthors, we wondered if there were any osteotomy similarities amongst us, hence the review to determine the location on radiographs,” he explains.

Identifying such a landmark is important, says Dr. Siddiqui, since MIS hallux valgus correction continues to become more common and acceptable for a multitude of bunion cases. He goes on to say that it is valuable to surgeons to have a “safe zone” in which to operate, aiming to decrease the likelihood of complications.

“I hope readers embrace that anatomy is king in everything we do, whether it is minimally or maximally invasive,” says Dr. Siddiqui, the Director of the Foot and Ankle Deformity Correction and Orthoplastics Fellowship in Baltimore. “In the MIS world it becomes imperative that we maintain the principles that have guided open surgery, which are predicated on atraumatic technique, early range of motion, stable fixation, and restoration of normal anatomy.”