Recurrence After Combined Minimally Invasive Transverse-Akin and Distal Minimally Invasive Metatarsal Osteotomies: Association With Preoperative Deformity Severity in a Multicentre Retrospective Cohort Study.

BACKGROUND: Recurrence after minimally invasive hallux valgus correction remains a concern, particularly following combined minimally invasive transverse-Akin (META) and distal minimally invasive metatarsal osteotomies (DMMOs). The influence of deformity severity on recurrence remains unclear. METHODS: This retrospective multicentre cohort study included 120 patients treated with combined META and DMMO between 2019 and 2024. Patients were stratified into mild, moderate, and severe deformity groups (n = 40 each). Radiographic outcomes and PROMIS scores were assessed preoperatively and at 3 and 12 months. Recurrence was defined as hallux valgus angle (HVA) > 20°. Multivariable logistic regression identified predictors of recurrence. RESULTS: All groups demonstrated significant radiographic correction and clinically meaningful PROMIS improvement. Recurrence rates at 12 months were 0% in mild, 30% in moderate, and 42.5% in severe deformities (P < .0001). Baseline HVA independently predicted recurrence (OR: 1.13 per degree; 95% CI: 1.07-1.21; P < .001). CONCLUSION: Combined META+DMMO was associated with substantial functional outcomes; however, recurrence increases substantially with deformity severity. LEVEL OF EVIDENCE: Level III, retrospective cohort study.