Percutaneous Hallux Valgus Surgery in 2013: Current Concept

Percutaneous surgery, which was introduced in France in 2002 under the auspices of the Group for Research and Study in Minimally Invasive Surgery of the Foot (GRECMIP), has contributed to a change in attitudes in recent years, shaking up numerous principles. If it appears particularly interesting to treat pathologies of lesser rays or small toes, it is totally different concerning the first ray, where its approach must be much more limited. We have analyzed the historic and "academic" procedure of Reverdin-Isham and we can retrospectively report its limits; thus, it should not be considered as the reference for the percutaneous hallux valgus treatment, even if, in expert hands and in very few indications, it can be useful. However, looking back, we can now say that it has contributed to the integration of the "percutaneous tool" in our daily practice. If the metatarsal osteotomy itself must be criticized, a number of elementary gestures, which are an integral part of the technique described by S. Isham in 1991, have become essential, such as the percutaneous Akin osteotomy of the proximal phalanx. Concerning the current evolution of first ray percutaneous surgery, it has entered a second and more mature period. This tool makes it possible to perform many of the techniques described to treat hallux valgus: distal chevron or basal osteotomies, metatarsophalangeal arthrodesis either in a distal approach or in a cuneo-metatarsal one (Lapidus procedure), provided you adapt them. Some approaches have been evaluated and we have now enough perspective on them. Others are still reserved for experts who report their experience more and more, as it was the case, in the 80s, for arthroscopy, with which it can be compared. This is why GRECMIP, by disseminating percutaneous and arthroscopic techniques all over the world, has contributed greatly to this fundamental change in surgical practice and remains at the heart of this mutation.