Percutaneous Chevron and Akin (PECA) Osteotomy for Bilateral Hallux Valgus: A Case Report and Literature Review

Abstract

Background: Hallux valgus, the lateral angulation of the big toe toward the lesser toes—commonly known as a bunion—is a complex foot deformity that can be considered in three planes: frontal, transverse, and sagittal. Coronal plane deformity, characterized by pronation of the first metatarsal, is present in up to 87% of individuals with hallux valgus. Its etiology is multifactorial, with clinical manifestations typically occurring between the third and fifth decades of life in approximately 65% of the population. Aims: This article aims to report a case of percutaneous surgical treatment of hallux valgus in a young patient with bilateral symptoms, highlighting the surgical technique employed, the clinical and radiographic outcomes, and discussing, based on current scientific literature, the indications, advantages, and limitations of the percutaneous approach compared to traditional open techniques. Presentation of Case: A 34-year-old female patient presented with bilateral pain and a bony prominence along the medial border of both feet, with symptom onset approximately two years prior. The discomfort was associated with difficulty wearing closed shoes and aesthetic concerns. Radiographic evaluation prior to surgery revealed an intermetatarsal angle (IMA) of 13° and a metatarsophalangeal angle (MPA) of 14°, indicating a moderate to severe deformity. The patient underwent bilateral percutaneous Chevron and Akin osteotomies (PECA) in early 2025. The procedure was uneventful. Postoperative radiographs demonstrated significant correction, with the IMA reduced to 7° and the MPA to 1°, confirming satisfactory anatomical alignment. Regarding pain, the patient reported a preoperative Visual Analog Scale (VAS) score of 8, which decreased substantially to 1 within the first postoperative week, indicating excellent pain control. Postoperatively, the patient initiated protected weight-bearing using a Barouk sandal during the first week. Full weight-bearing was allowed after one week, with painless and progressive recovery. Discussion: Hallux valgus, commonly referred to as a bunion, is a foot deformity characterized by lateral deviation of the hallux and medial deviation of the first metatarsal. It is frequently associated with pain, discomfort when wearing footwear, and functional limitations. The condition has a multifactorial etiology, with a higher prevalence among older women. Initial management typically involves conservative treatment, including orthotics, physical therapy, and footwear modifications. However, when conservative measures fail, surgical correction becomes indicated. In recent years, minimally invasive techniques such as percutaneous Chevron and Akin (PECA) have gained prominence due to their favorable outcomes. Compared to conventional open procedures, the PECA technique offers several advantages, including smaller incisions, reduced soft tissue trauma, faster recovery, lower postoperative pain levels, and fewer wound complications. Nonetheless, successful outcomes depend on appropriate patient selection, precise surgical planning, and adequate surgeon training, as the learning curve for minimally invasive techniques can be steep. This case is particularly relevant as it involves a young patient, a demographic less frequently discussed in the current literature, which typically focuses on older populations. Conclusion: The success of this procedure was attributed to accurate indication, meticulous surgical planning, and the surgeon’s proficiency with the percutaneous technique. This case also reinforces the importance of health education, both for patients—who must be informed about their therapeutic options—and for medical professionals, who need continuous updates on advances, benefits, and limitations of minimally invasive techniques for hallux valgus correction. Sharing this case contributes to the growing body of evidence supporting the PECA technique as a safe, effective, and less invasive alternative to traditional approaches. Furthermore, it demonstrates how this method can result in excellent functional and aesthetic outcomes, even in younger patients, with significant pain reduction and rapid postoperative recovery.