40 patients with symptomatic mild to moderate hallux valgus were enrolled into this randomized trial. Patients were randomized in a 1:1 ratio to undergo either minimally invasive transverse distal metatarsal osteotomy with percutaneous Akin osteotomy (MITO) or open chevron-Akin osteotomy. All randomized patients were included in the final analysis. The outcomes of interest were postoperative wound-healing scores assessed using the Photographic Wound Assessment Tool (PWAT) and ASEPSIS score at 6 weeks, 3 months, and 6 months. Other outcomes included patient-reported outcome measures (VAS pain, FAAM, SF-36), AOFAS score, and radiographic parameters including intermetatarsal angle and metatarsal length. Outcomes were assessed preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Overall, the results of the study revealed a significantly better PWAT score favouring the minimally invasive technique at 6 weeks, with no differences thereafter. At one year, both surgical techniques resulted in substantial and comparable improvements in functional scores and radiographic correction, with similar complication rates.