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12/28/2016 Burton J. Katzen, DPM
The MIS Akin Osteotomy (Dieter J. Fellner, DPM)
I have been performing the MIS metatarsal osteotomy for correction of hallux valgus deformity since 1980, and let me first say that I appreciate the need for extensive scientific studies for any procedure that we want to classify as an accepted standard of care. Also, The Academy of Ambulatory Foot and Ankle Surgery is extremely fortunate to have members like Drs. Peacock, Nadal, and Isham who are very scientifically-oriented in their evaluations, and we are equally as fortunate to have someone like Dr. Block who is finally making the profession aware of the excellent work performed on a daily basis by our members here and all over the world.
That being said, my contribution to the discussion only comes from a vast amount of anecdotal experience involving thousands of cases over many years. I do look forward in the future to working with my esteemed colleagues in producing a scientific study on the procedure. The osteotomy is performed with four separate cuts at differing angles to achieve correction and lateral displacement of the first metatarsal head with minimal dorsi or plantar flexion (if not desired). In my experience, I do not find it necessary to perform lesser metatarsal osteotomies with few exceptions, and I have rarely experienced transfer lesions.
My own feeling is that by reducing the IM angle, even if you are getting minimal shortening, you are producing a more stable 1st ray (sort of like holding your fist extended as compared to tight against your body). Even in some cases if you see a minimal amount of dorsiflexion, it has not been my experience that this produces a transfer lesion. After correction is obtained, I find it necessary to remove the "bump" in about 50% of the cases.
I will occasionally also perform and Akin MIS procedure to obtain a more pleasing cosmetic result. As far as long-term follow-up goes, we traditionally phone our patients one year after surgery, and the overwhelming majority are extremely happy with the results and state they are glad they had it done. We have been following this procedure for about 3 years, and, to date, no one has mentioned a transfer lesion. I might also add that approximately 10- 15% of our bunion patients had one foot done traditionally and never went back for the second. These are the happiest patients.
In conclusion, my only advice to my colleagues is that I believe these procedures have great value in correcting a multitude of foot problems with minimal down time to the patient and out of the office time to the surgeon, and I suggest these are skills that each individual should learn and evaluate for themselves. Burton J. Katzen, DPM, Temple Hills, MD
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