Acupotomy to Treat Inversion of the Second Toe Combined with Eversion of the First Metatarsophalangeal Toe: A Case Report.

BACKGROUND Hallux valgus (HV), characterized by lateral deviation of the first metatarsophalangeal joint (MJ) and medial metatarsal protrusion, frequently causes pain and gait dysfunction. Conventional treatments face limitations in efficacy or invasiveness. Acupotomy is a minimally invasive microsurgery technique that uses a needle knife and microtrauma to detach tissue associated with contractures. It may be used with or without ultrasound guidance. This report describes the case of a 52-year-old woman with varus deformity of the second toe and valgus deformity of the left first metatarsophalangeal joint that was managed with minimally invasive acupotomy. CASE REPORT A 52-year-old woman presented with a 5-year history of left foot pain, second toe varus, and first metatarsophalangeal valgus, worsening with activity despite conservative management. Symptoms included callus formation and limited joint mobility. Diagnosed with both deformities, she underwent 6 acupotomy sessions targeting the medial first MJ capsule, adductor/abductor pollicis tendon insertions, second toe flexor sheath, medial second MJ capsule, and intermetatarsal ligament, followed by dynamic traction and muscle training. Immediate post-treatment results showed second toe varus angle (TVA) reduction ≥15°, passive extension improvement >10°, and hallux valgus angle (HVA) decrease ≥5°. At 2-month follow-up, TVA further improved ≥18°, passive extension increased >13°, HVA stabilized ≥5° reduction, and pain as measured on the visual analogue scale decreased to 3 points. CONCLUSIONS Acupotomy effectively restored foot biomechanics by releasing soft tissue contractures and redistributing plantar stress, achieving mechanical correction and functional recovery. This minimally invasive approach demonstrates promise for mild-to-moderate HV with secondary deformities, particularly for which surgery is contraindicated. Further studies are warranted to standardize protocols and validate long-term efficacy.