Gender Differences in Early Recovery After Minimally Invasive Distal Transverse Metatarsal Osteotomy - Akin Osteotomy (MITA) for Hallux Valgus: A Propensity-Matched Study of 300 Cases

Background Evidence regarding sex-based differences in outcomes after minimally invasive distal transverse metatarsal osteotomy - Akin osteotomy (MITA) for hallux valgus remains limited. This study compared clinical and radiographic outcomes and complication rates between male and female feet using a propensity score–matched cohort. Methods This retrospective study included 300 feet (150 male and 150 female) that underwent MITA. Male and female feet were matched using propensity scores based on age, preoperative hallux valgus angle (HVA), and preoperative intermetatarsal angle (IMA). Clinical outcomes were assessed using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Manchester–Oxford Foot Questionnaire (MOXFQ). Radiographic outcomes included HVA, IMA, and bony foot width. Assessments were performed preoperatively, at 3 months postoperatively, and at 1 year. Results After propensity matching, baseline age (53.6 vs 53.8 years), HVA (31.2° vs 31.1°), and IMA (14.2° vs 14.2°) were comparable between groups. Preoperatively, male feet showed worse clinical status, with lower AOFAS scores (66.6 ± 13.5 vs 69.7 ± 10.7; p = 0.03), despite similar radiographic deformity. At 3 months postoperatively, male feet showed better early clinical outcomes, including lower VAS pain scores (0.2 ± 0.4 vs 0.5 ± 0.8; p < 0.001), higher AOFAS scores (91.2 ± 2.0 vs 90.3 ± 3.0; p = 0.002), and lower MOXFQ pain scores (12.0 ± 6.0 vs 16.0 ± 10.1; p < 0.001). At 1 year, clinical outcomes were comparable between groups. Radiographic correction of HVA and IMA was similar between groups at both 3 months and 1 year. Complication rates were low and comparable between groups. Conclusions Male feet undergoing MITA present with worse baseline functional impairment but show greater early postoperative improvement, with clinical and radiographic outcomes comparable to those of female feet at 1 year. These findings suggest that sex influences early recovery trajectory but not 1-year effectiveness of MITA. Trial registration not applicable