Seventy-four patients with severe hallux valgus deformity were randomized to receive minimally invasive proximal chevron Akin osteotomy (p-MICA) (n=40) or minimally invasive distal chevron Akin osteotomy (d-MICA) (n=41). The primary outcome of interest was the proportion of patients with unsatisfactory correction (hallux valgus angle (HVA) > 15° at final follow-up). Secondary outcomes included changes in HVA, intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative second metatarsal length, and functional scores (FAAM-ADL and FAAM-Sports). Outcomes were assessed over a minimum follow-up of two years. Overall, the results revealed that both p-MICA and d-MICA significantly reduced HVA and IMA, but the d-MICA group had a higher incidence of unsatisfactory correction at final follow-up. p-MICA better maintained correction but had a higher postoperative DMAA. These findings suggest that p-MICA may provide a more reliable correction of severe hallux valgus, while d-MICA may be less predictable in achieving optimal alignment.