Table 1.

Summary of Recommendations on the third generation minimally invasive surgery for hallux valgus.

	Recommendations
Indications & Contraindication	1. Third generation MIS technique is an effective modality for surgical correction of patients with mild to moderate hallux valgus.
	2. For patients with severe hallux valgus, the surgical planning and strategy should be assessed on a case-by-case basis considering the patient's individual pathology and the expertise of the surgeon.
Pre-Operative	1. Radiation protection precautions for both patients and surgeons are necessary, despite the relative low dose of radiation.
	2. It is preferable and advisable to use a specialized power system that meets the requirements of low speed and high torque power setting.
	3. Selection of an appropriate type and size of Shannon burr is crucial for achieving optimal outcomes during osteotomy procedures.
Intra-Operative	1. Third generation MIS adopts an extracapsular osteotomy site proximal to the neck of the first metatarsal.
	2. The direction and angle of the osteotomy should be carefully planned and executed to achieve the desired correction while minimizing the complications.
	3. Specialized reduction tools are recommended for effective reduction.
	4. It is important to note that there is a learning curve in achieving reliable osteotomy, reduction and internal fixation.
	5. The severity of hallux valgus is closely related to the degree of lateral translation required for metatarsal head realignment.
	6. Guide pins for fixation screws should be inserted before osteotomy.
	7. The “in–out-in” technique is critical when inserting screws to achieve sufficient stability.
	8. Fully threaded cannulated screws are advocated to enhance stability.
	9. It is still controversial whether lateral soft tissue release is necessary in MIS for hallux valgus.
Post-Operative	1. Standard dressing technique or a special brace to maintain the hallux in a neutral position is recommended post-operatively for 4–6 weeks.
	2. It is crucial to implement standardized functional rehabilitation program to maintain the surgical outcome and prevent complications such as joint stiffness.
	3. It is important to note the risks of post-operative complications in MIS for hallux valgus despite its advocated advantages of a less invasive approach than the traditional open osteotomy surgery.