JULY 2007 | Volume 30 • Number 7 523 ■ the cutting edge Minimally Invasive Surgery in Hallux Valgus and Digital Deformities Atilio Migues, MD; Gustavo Campaner, MD; Gastón Slullitel, MD; Pablo Sotelano, MD; Marina Carrasco, MD; Gabriel Solari, MD Drs Migues, Campaner, Slullitel, Sotelano, Carrasco, and Solari are from the Institute of Orthopedics, “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Argentina. Correspondence should be ad- dressed to: Gustavo Campaner, MD, Institute of Orthopedics, “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, C1199ACK, Argentina. S everal surgical tech- niques have been de- scribed for the treatment of hallux valgus and lesser toe deformities. 1-4 However, lack of agreement exists regarding which technique is the most efficacious. Minimally invasive tech- niques have become increas- ingly popular in orthopedics. The application of these con- cepts in hallux valgus has been questioned in the past, in part due to the lack of sci- entific validation. However, recent studies have shown sat- isfactory results using these techniques. 5-7 This article describes the minimally invasive tech- niques we use at the Italian Hospital of Buenos Aires and their indications in the treat- ment of hallux valgus and lesser digital deformities. All techniques are performed as outpatient procedures under ankle or popliteal block with the patient supine and the operative foot positioned off the end of the table. 8 Fluo- roscopy is useful to monitor the performance of some of the steps. BÖSCH TECHNIQUE Indications The Bösch technique is used to treat mild to moderate hallux valgus with an inter- metatarsal angle of 10 to 20 and a distal metatarsal articu- lar angle 10. Surgical Technique A 2-mm incision is made in the medial side of the great toe, approximately 5 mm plan- tar to the proximal edge of the nail (Figure 1). The wire en- trance may be located dorsally when plantar metatarsal head displacement is desired, and plantarly if dorsal metatarsal head displacement is chosen. A second incision is made at the subcapital region of the first metatarsal, equidistant between the dorsal and plantar aspects of the bone (Figure 2). A 2-mm Kirschner wire is in- serted retrograde from the first to the second incision (Figure 3). The K-wire must be placed subcutaneously and extraperi- osteally to perform the meta- tarsal head displacement at the osteotomy site. In the proximal incision, the periosteum is detached dorsally and plantarly with a small elevator, preserving its continuity to protect the soft tissues during the osteotomy. The osteotomy is made in the first metatarsal subcapi- tal region under fluoroscopic control, using an end cutting burr Shannon 44 (Miltex In- strument Co Inc, York, Pa). First, a pilot hole is made from medial to lateral. Using 1 2 Figure 1: A 2-mm incision is made in the medial side of the great toe, ap- proximately 5 mm plantar to the proxi- mal edge of the nail. Figure 2: A second incision is made at the distal metaphy- sis of the first metatarsal, equidistant between the dorsal and plantar aspects of the bone. Figure 3: A 2-mm K-wire is inserted in retrograde form from the first to the second incision. 3 Minimally invasive surgical techniques are an alternative with potential advantages in the treatment of forefoot deformities.