Is it necessary to fix the Akin osteotomy in the minimally invasive hallux valgus correction? Prospective randomized controlled trial with a minimum follow-up of two years

Abstract

Introduction: The need for fixation of Akin osteotomy associated with minimally invasive hallux valgus correction remains controversial. Methods: Consecutive patients undergoing minimally invasive hallux valgus correction with Akin osteotomy were randomized to two treatment arms. Outcomes were collected before the procedure and at the final assessment (at least 2 years later). Pre-versus-post comparisons were performed using a paired t-test or a Wilcoxon test, according to the distribution of paired differences (two-tailed alpha = 0.05). Results: Forty-six [AC1] participants (23 in group 1, 22 in group 2) were included; pain (VAS) decreased from a median of 7 to 0 (p < 0.001), and the AOFAS score increased from 60.5 ± 8.3 to 93.2 ± 7.4 (p < 0.001). Radiographic correction was significant: HVA decreased from 32° to 6° (p < 0.001) and IMA from 14.3 ± 2.9° to 6.6 ± 1.8° (p < 0.001). The IMA showed no statistically significant change (7.6 ± 4.4° to 9.8 ± 6.0°; p = 0.059). In the final evaluation, consolidation of Chevron and Akin was observed in all cases. The mean follow-up was 31.2 months. Conclusion: In this prospective randomized controlled trial, there was significant clinical improvement and sustained radiographic correction at the end of two years, with high consolidation and satisfaction rates.