Fig. 2.

Intra-operative fluoroscopy images demonstrating the key operative steps of the third generation percutaneous minimally invasive metatarsal transverse osteotomy (A) Transverse extra-articular osteotomy (B) Lateral translation of the first metatarsal head using a MIS reduction tool, and temporary fixation with Kirschner-wires to avoid loss of reduction (C) Insertion of the first full-threaded cannulated screw through the guide pin (D) Insertion of the second cannulated screw in a similar manner (E) Percutaneous Akin osteotomy (F) Placement of guide pin after Akin osteotomy (G) Percutaneous Akin osteotomy fixation (H) Final correction.