Minimally invasive and percutaneous surgery of hallux valgus: what has been abandoned, retained or modified after 20 years?

Hallux valgus remains the leading reason for consultation in forefoot pathology, and its surgical management has been profoundly transformed over the past two decades by the advent of minimally invasive and percutaneous techniques. More than 150 operative procedures had already been described by the mid-2000s, yet the question of which approach best serves the patient continues to generate debate. This article offers a critical synthesis of the current practice of the TALUS group — a French-speaking collective of foot and ankle surgeons — in the light of twenty years of evolution, with the aim of clarifying what has been abandoned, retained or modified in everyday forefoot surgery. The reflection draws on the members’ pooled experience, a review of the pertinent literature, and the educational activity of the GRECMIP / MIFAS learned society, from which the hybrid minimally invasive chevron and subsequent fully percutaneous procedures such as the MICA have emerged. The authors review the radioclinical keys to operative decision-making, including the intermetatarsal and hallux valgus angles, the distal articular angles (DMAA/TASA), cuneometatarsal mobility, the metatarsal formula, joint congruence, head pronation and patient-related factors. They then examine, technique by technique, the fate of the Isham–Reverdin procedure (now largely abandoned), the scarf osteotomy (progressively relinquished in favour of the chevron or of fixed bipolar and Lapidus procedures), the minimally invasive and percutaneous chevron (which has become the workhorse of the group), the bevelled (“biseau”) osteotomy, basal osteotomies and arthrodeses. Points that remain debated — Akin fixation, sesamoid repositioning, correction of metatarsal pronation, shortening of the first ray, one-stage versus two-stage management and indications for arthrodesis — are discussed in turn. A decision-making algorithm is proposed according to the severity of the deformity (mild, moderate, severe/XXL). The article will be of value to foot and ankle surgeons, trainees and general orthopaedic surgeons seeking a pragmatic, experience-based framework for selecting among the ever-expanding armamentarium of first-ray procedures.