Minimally Invasive vs Open Distal Metatarsal Osteotomy for Hallux Valgus: A Randomized Controlled Trial of Short-term Wound Healing and 1-Year Outcomes

Background: Hallux valgus (HV) often requires surgical intervention following the failure of conservative treatment. This study compared the minimally invasive transverse distal metatarsal osteotomy and percutaneous Akin (MITO) technique with open chevron Akin (OC) surgery over 1 year in patients with mild to moderate HV. Methods: In this prospective randomized controlled trial, 40 patients (40 feet) were randomized to receive MITO (20 feet) or OC (20 feet) between January 2019 and 2022. Follow-up was conducted at 6 weeks, 3 months, 6 months, and 1 year postsurgery, with evaluations including assessment of wound healing using the PWAT and ASEPSIS scores, patientreported outcome measures (PROMs), AOFAS scale, and radiologic measures. Results: There were no notable differences in surgical time, PROMs, AOFAS scale, or radiologic results at the 1-year follow-up. The only significant difference observed was the PWAT score at the 6-week mark, favoring the MITO group. Overall, the complication rate stood at 15% for both groups, with no reports of significant complications. Conclusion: At the 6-week mark, the MITO technique demonstrated beneficial progress in postoperative soft tissue evolution. At the 1-year follow-up, both groups improved regarding radiologic outcomes. This study supports the shortterm benefit of percutaneous techniques on early wound healing, while confirming similar 1-year functional and radiographic outcomes compared to open techniques. Level of Evidence: Level I, prospective randomized controlled trial.