Return to daily and sports activities after minimally invasive transverse osteotomy and Akin (META) for Hallux Valgus: setting realistic expectations

Background: Although minimally invasive transverse osteotomy and akin (META) for hallux valgus has demonstrated favorable radiological and patient-reported outcome measures, these do not capture the practical questions patients typically ask, such as when they can return to driving, work, wearing shoes, or resume sports. Purpose: This study aimed to identify the timeframe to return to daily activities and sports after META. Secondarily, to explore potential perioperative factors that may influence this timeframe. Study design: Prospective cohort. Methods: Seventy-five consecutive adults underwent META between September 2023 and December 2024. The primary outcome was the timeframe to return to 8 activities, measured using a purpose-designed questionnaire administered at least 3 months postoperatively. Secondary outcomes were explored using multivariable quantile regression. Results: Fifty-seven eligible patients (90 feet) completed follow-up (mean 12.4 months). Median return times (weeks, IQR): wide shoes 3.0 (2–4), driving 4.0 (2–5), work 4.0 (2–5), normal walking 4.0 (3–6), athletic footwear 6.0 (4–8), low-impact sports 8.0 (5.5–10), regular footwear 12.0 (6.5–16), and high-heels 16.0 (13.5–20.5). The absence of previous physical activity delayed driving among slower recoverers (P90: β + 6.5 weeks; 95% CI 2.3–10.8; p = 0.004), bilateral procedures delayed work return (P75: β + 4.1 weeks; 95% CI 1.5–6.7; p = 0.004), concomitant lesser toe procedures delayed athletic footwear transition (P50: β + 3.0 weeks; 95% CI 0.7–5.3; p = 0.013), and physical therapy showed no consistent association after age adjustment. Conclusions: Most patients resumed driving, work, and normal walking by 4 weeks, low-impact sports by 8 weeks, and footwear transitions over 3–16 weeks, providing empirical milestones for perioperative counseling after META.