First-year experience with MICA technique: learning difficulties, mistakes, and results

BACKGROUND: Hallux valgus is a very common forefoot disorder, first named by Carl Hueter (1871) as a condition with a static subluxation of the first metatarsophalangeal joint with lateral deviation of the great toe and medial deviation of the first metatarsal. It usually leads to pain and functional impairment of the foot. With the continuous evolution of technology and the idea to shift open Austin Akin osteotomy to MIS surgery, more recently Redfern and Vernois developed the Minimally Invasive Chevron Akin (MICA) technique. The use of this technique has been vastly studied by the authors, but to our knowledge there is a scarce literature production by independent authors reporting their experience in the use of this technique. The aim of the present study was to show our preliminary results in the use of MICA technique performed by the same surgeon during his first year of use, underlining the learning difficulties, mistakes and results achieved during this frame of time. METHODS: The MICA procedure was performed on 60 feet from July 2018 to July 2019. A follow-up of at least 11 months was achieved. The clinical outcome was measured through AOFAS Score. RESULTS: The mean patients age was 51.5 years old (range: from 36 to 72 years old). The mean AOFAS Score was 90.4, interestingly 24 patients (40% of the total of 60 patients) had AOFAS Score set over 90. CONCLUSIONS: MICA osteotomy marries percutaneous surgery with the Austin Akin osteotomy, that have been and are widely used for the treatment of hallux valgus. It is possible to achieve the good results of a well know surgery with a stable fixation and obtain all the goals of percutaneous surgery, such has limited pain, good postoperative range of motion and an overall positive experience of the patient. The learning curve, if the surgeon is correctly instructed, is steep, but the results are good since the first procedures. On the other hand, the complications/surgical errors reported are limited, easily resolvable and do not impact the overall positive results.