Not All Minimally Invasive Hallux Valgus Osteotomies Are Equal: A Comparative Analysis of First Metatarsal Shortening After Reverdin-Isham and Wilson Osteotomies

<title>Abstract</title> <p>Background Minimally invasive surgery is increasingly used for hallux valgus correction, but the effect of different osteotomy designs on first metatarsal length preservation remains poorly studied. This study compared first metatarsal shortening after Reverdin-Isham and Wilson minimally invasive osteotomies. Methods A retrospective comparative observational study was conducted in 60 feet from 60 patients who underwent minimally invasive hallux valgus surgery between January 2024 and May 2026. Thirty feet were treated with the Reverdin-Isham osteotomy and thirty with the Wilson osteotomy. Standardized weight-bearing dorsoplantar radiographs were obtained preoperatively and at 3 months postoperatively. First metatarsal shortening was calculated as the difference between preoperative and postoperative metatarsal length. Results The Wilson osteotomy produced significantly greater first metatarsal shortening than the Reverdin-Isham technique. Mean shortening was 0.613 ± 0.209 in the Wilson group and 0.429 ± 0.138 in the Reverdin-Isham group, with a mean between-group difference of 0.184 (95% CI, 0.091–0.276; p &lt; 0.001). The effect size was large (Cohen’s d = 1.03). Relative shortening was also greater after Wilson osteotomy, reaching 10.95 ± 3.82% compared with 7.37 ± 2.65% after Reverdin-Isham osteotomy. Conclusion The Wilson osteotomy was associated with significantly greater first metatarsal shortening than the Reverdin-Isham technique. These findings suggest that not all minimally invasive hallux valgus osteotomies have the same effect on first-ray length preservation, which may be relevant for surgical planning and forefoot biomechanics.</p>