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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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