Minimally invasive chevron-Akin osteotomy. A, Initial stab incisions. B, Dorsal and plantar cuts of chevron osteotomy using a Shannon burr. C, Varus force applied with 2-mm Kirschner wire from translation of distal fragment (arrow shows targeted far cortex for initial guide pin, which enables three-point screw fixation). D, Clinical photo. Index finger supports metatarsal head to maintain alignment (asterisk). E, Correction maneuver for pronation. Supination force is applied as demonstrated by arrow. F, Three-point fixation of first proximal screw (arrows) and guide pin for second screw (asterisk). G, Initial placement of Shannon burr for apex of Akin osteotomy. H, Placement of screw after Akin osteotomy. I, For distal soft-tissue procedure, beaver blade is introduced from dorsum of first metatarsophalangeal joint lateral to extensor hallucis longus tendon. J, As varus force is applied to great toe, blade divides lateral plantar plate and lateral sesamoid phalangeal ligament. (From Lee M, Walsh J, Smith MM et al: Hallux valgus correction comparing percutaneous chevron/Akin (PECA) and open scarf/Akin osteotomies, Foot Ankle Int 38:838, 2017.) SEE TECHNIQUE 82.9.