Development and exploration of percutaneous hallux valgus surgery

Background: Hallux Valgus is a common forefoot deformity that causes problems with pain, mobility, footwear, and affects health - related quality of life. Traditional surgical treatment involves open surgery although percutaneous or minimally invasive surgery is gaining popularity . The evolution and development of percutaneous Hallux Valgus surgery has occurred without adherence to structured evaluation frameworks of surgical innovation . Developments have been driven primarily by technical modifications and individual surgeon ex perience rather than robust evidence from randomised controlled trials . Early systematic reviews of minimally invasive Hallux Valgus surgery suggest potential patient benefits includ e reduced post - operative pain and smaller scars; however, the technique has been developed incrementally without evaluation with large inter - operator variability . The aim of this thes i s was to provide early technical, outcome and safety profile data aligned , with IDEAL stages 2 A (Development) and 2 B (Exploration) , to inform the design of future clinical trials . Methods: Over six years, I conducted a series of observational studies exploring percutaneous Hallux Valgus surgery . This enable d consideration of technical refinements and clinical outcomes using the IDEAL framework designed specifically for early - phase surgical research . The research was not originally conducted in chronological alignment with the IDEAL framework . However, it is presented here using that structure to enable readers to assess the development and exploration of the percutaneous Hallux Valgus techniq ue. By focusing on standardi s ed validated outcome measures and technical parameters across multiple studies, this work aim ed to help build the foundations for future clinical trials , whil st acknowledging the inherent limitations of early - phase evaluation using observational designs . Results: T his thesis explored key aspects of percutaneous Hallux Valgus surgery: o Optimi s ation of Biomechanical Fixation: towards standardised screw positioning and fixation techniques o Safety Profile: C apture of complications using classification systems o Clinical Outcomes: Assessment of recovery using validated patient - reported and radiographic outcome measures o Expanding Indications: Demonstration of technical feasibility in severe deformity o Learning Curve: Exploration of surgical volume needed for technical proficiency o Mid - term Outcomes: Assessment of complications at five - year follow - up o Technical Evolution: Exploration of different osteotomy configuration from chevron to transverse distal metatarsal osteotomy Conclusion: This thesis presents a series of observational studies contributing to early - phase evaluation, exploration and development of percutaneous Hallux Valgus surgery . While the findings provide foundation for future research, the methodological limitations inherent in these early - phase studies , particularly lack of controls and high risk of bias , limit definitive conclusions about clinical effectiveness. Nevertheless, this work has explored fundamental aspects of modern percutaneous Hallux Valgus surgery, helpin g establish the foundation for future progression to more methodologically robust multi - centre studies .