Objective To compare the efficacy of the fourth-generation minimally invasive technique—minimally invasive extra-articular metaphyseal distal transverse osteotomy (META) and Chevron osteotomy (minimally invasive Chevron and Akin osteotomy, MICA) in treatment of hallux valgus. Methods A total of 80 patients with hallux valgus who underwent single-foot surgery between July 2023 and January 2025and met the inclusion criteria, were included in the study. Among them, 40 patients were treated with META and 40 with MICA. There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, height, weight, body mass index, disease duration, lesion site, hallux valgus deformity degree, as well as preoperative scores of each item in the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale (AOFAS-Hallux-MTP-IP), scores of each item in the Manchester-Oxford Foot Questionnaire (MOXFQ), hallux valgus angle (HVA), the intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, and the 1st metatarsal head morphology. The postoperative AOFAS-Hallux-MTP-IP scores (pain, function, alignment, total score), MOXFQ scores (pain, walking/standing, social interaction, total score), as well as HVA, IMA, DMAA, the 1st metatarsal head morphology, and sesamoid position measured based on weight-bearing foot X-ray films were compared between the two groups; the occurrence of postoperative complications was recorded. Results All patients in both groups were followed up 6-18 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). At last follow-up, the scores of all items in AOFAS-Hallux-MTP-IP in both groups were higher than those before operation, and the scores of all items in MOXFQ were lower than those before operation, with significant differences (P<0.05); there was no significant difference in the change values of all item scores in MOXFQ between the two groups (P>0.05). The change value in AOFAS function score in the META group was significantly higher than that in the MICA group (P<0.05), while there was no significant difference in the change value of AOFAS pain score, alignment score, and total score between the two groups (P>0.05). After operation, 1 case (2.5%) of superficial incision infection and 2 cases (5.0%) of numbness around the incision occurred in the MICA group, while only 2 cases (5.0%) of numbness around the incision occurred in the META group. Imaging reexamination showed that HVA, IMA, and DMAA in both groups were signifncatly smaller than those before operation (P<0.05), and there was no significant difference in the change values of the above angles between the two groups (P>0.05). The 1 st metatarsal head morphology and sesamoid position in the META group were better than those in the MICA group after operation, with significant differences (P<0.05). Conclusion Both META and MICA can correct hallux valgus deformity, improve foot function, and relieve pain, but META has more advantages in correcting metatarsal rotation and reducing dislocated sesamoids.