Objective To explore the clinical efficacy and safety of minimally invasive osteotomy and reduction technique in the treatment of moderate to severe hallux valgus deformity. Methods A retrospective analysis was conducted on the clinical data of patients with moderate to severe hallux valgus deformity admitted to Taihe Hospital of Traditional Chinese Medicine Affiliated to Anhui University of Chinese Medicine from June 2023 to January 2025. The baseline data were balanced using the propensity score matching (PSM) method with a 1vs.1 nearest neighbor matching approach. The cutoff value was set at 0.2. After matching, there were 40 cases in each group: the minimally invasive group (receiving minimally invasive osteotomy and reduction technique) and the traditional group (using the traditional Scarf osteotomy technique). The surgical time, intraoperative blood loss, hospital stay, fracture healing time, hallux valgus angle (HVA) before and 12 months after the operation, the intermetatarsal angle (IMA), the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, the visual analogue scale (VAS) score, and the occurrence of complications were compared between the two groups. Results The perioperative indicators of the minimally invasive group were all better than those of the traditional group (all P＜0.05). At 12 months after surgery, the HVA, IMA, AOFAS score, and VAS score of the two groups were significantly improved compared with those before surgery (all P＜0.05), and the improvement degree of the minimally invasive group was better than that of the traditional group (all P＜0.05). The total incidence of complications in the minimally invasive group was lower than that in the traditional group (P＜0.05). Conclusion Minimally invasive osteotomy and reduction technique for the treatment of moderate to severe hallux valgus deformity has the advantages of small trauma, quick recovery, satisfactory orthopedic effect, and high safety, and is worthy of clinical promotion and application.