Comparison of third-generation minimally invasive surgery, split-drill osteotomy, and triplanar chevron osteotomy for treating mild to moderate hallux valgus with metatarsalgia in middle-aged women: An observational study.

This retrospective study compared the clinical efficacy of third-generation minimally invasive surgery (3rd-MIS) split-drill osteotomy with soft tissue release to that of triplanar chevron osteotomy (TCO) for treating mild to moderate hallux valgus (HV) with metatarsalgia in middle-aged women. This study compared the efficacy of 3rd-MIS using split-drill osteotomy to that of TCO in treating mild to moderate HV with metatarsalgia in 52 middle-aged women from March 2022 to June 2023. Retrospectively analyzing a total of 52 patients (26 patients per group), we employed 2 distinct surgical methods across 2 groups in this study: the TCO group received a traditional TCO accompanied by soft tissue release, whereas the MIS group underwent a split-drill osteotomy with soft tissue release. The study compared the operation time, onset of weight-bearing, osteotomy healing, blood loss, pre- and postsurgery X-ray measurements, metatarsalgia, and foot function scores. In the TCO group, complications included peri-incisional numbness, elevation of the first metatarsal head with metatarsalgia, and bone hyperplasia with stiffness at the MTPJ in one patient each. In the MIS group, bunions were successfully corrected without significant complications like bone nonunion or avascular necrosis of the metatarsal head, and the metatarsal length was preserved. Significant differences in operation time, weight-bearing onset, healing, and blood loss were detected between groups (P < .05). Preoperatively, there were no significant differences in hallux valgus angle, 1-2 intermetatarsal angle, or distal metatarsal articular angle among the groups (P > .05). Nonetheless, notable postoperative differences were observed (P < .05). Foot function and pain scores, assessed by the American Orthopaedic Foot & Ankle Society and the Visual Analogue Scale, showed significant improvements in both groups following surgery. Both surgical techniques effectively corrected the HV angle without significant changes in the first metatarsal length. The MIS group experienced significantly less pain on the second day postsurgery, as indicated by lower Visual Analogue Scale scores (P < .05). Both techniques were similarly effective in treating metatarsalgia. 3rd-MIS split-drill osteotomy with soft tissue release offers several advantages over TCO techniques for treating mild to moderate HV with metatarsalgia in middle-aged women, such as reduced trauma, quicker healing, smaller scars, and less pain after surgery.