MICA: A Learning Curve

Ezequiel Palmanovich*, Nissim Ohana, Ran Atzmon, Omer Slevin, Yaron Brin, Viktor Feldman, David Segal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Techniques of minimally invasive bunion surgery have become increasingly popular in recent years. However, the learning curve involved in mastering these innovative techniques has not been described. To address this issue, a trained foot and ankle surgeon in a university hospital operated on 50 patients using the minimally invasive Chevron and Akin procedure over the course of 3 years, from January 2016 through December 2018. Surgery duration and x-ray exposure were documented. Results showed that surgery duration decreased from >2 hours in the first cases to a mean of ∼45 minutes in the third year. This learning curve plateaued by the 21st patient. The number of intraoperative fluoroscopy studies used decreased substantially over the first 27 surgeries, at which point the learning curve plateaued. In summary, it took about 27 procedures for an inexperienced surgeon to acquire the skill of performing minimally invasive Chevron and Akin osteotomy.

Original languageEnglish
Pages (from-to)781-783
Number of pages3
JournalJournal of Foot and Ankle Surgery
Issue number4
StatePublished - 1 Jul 2020


  • 3
  • Chevron and Akin (MICA)
  • bunion surgery
  • hallux valgus
  • learning curve
  • minimally invasive
  • osteotomy


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