Skip to content

Clinicians › Foot

Hallux valgus correction

58 citationsUpdated Oct 2026
Illustration: foot

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Hallux valgus correction encompasses a broad spectrum of surgical techniques, ranging from percutaneous and minimally invasive approaches to conventional open osteotomies. Percutaneous forefoot surgery produces results similar to conventional surgery [1], while minimally invasive distal linear osteotomy achieves clinical and radiographic outcomes comparable to open techniques with decreased recovery times [18]. For mild to moderate deformities, the Austin osteotomy is safe and effective [2], and the chevron osteotomy remains a reliable procedure with outcomes that do not differ on the basis of age [7]. Modified minimally invasive chevron osteotomy and traditional incision chevron osteotomy both effectively treat mild to moderate deformity with significantly improved clinical efficacy and imaging results [13]. The syndesmosis procedure yields satisfactory short-term clinical and radiological results two years post-operatively [3], and fourth-generation percutaneous transverse osteotomies demonstrate significant improvement in clinical and radiographic outcomes with a low rate of recurrence [12].

Indications vary by severity and patient factors. Proximal osteotomy is a good method for treating severe hallux valgus deformity, with 86% of patients stating the operation was worthwhile after 8 years of follow-up [14]. The combined proximal opening wedge and distal chevron osteotomy is a reliable technique for moderate to severe hallux valgus, providing strong angular correction with satisfactory clinical outcomes [21]. Proximal first metatarsal osteotomy in combination with a lateral soft-tissue procedure is effective in correcting moderate to severe symptomatic hallux valgus deformity with metatarsus primus varus [10]. The Hohmann and Lapidus operations are good options for correction of a hallux valgus deformity, with similar reliable long-term results [15]. Obesity was not associated with unsatisfactory outcomes after reversed L-shaped osteotomy, challenging previous recommendations for preoperative weight loss [16]. Minimally invasive surgery for juvenile hallux valgus allows another surgery to be done on minimally or undamaged tissues if needed later on [17]. Modified endoscopic distal soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation is indicated for symptomatic hallux valgus recalcitrant to conservative treatment but is contraindicated in cases with bony deformity or where the intermetatarsal space cannot be closed manually [24].

Technical considerations and complication management are critical for optimal outcomes. Avoiding the potentially dangerous zone of the dorsomedial cutaneous nerve is recommended during minimally invasive surgery [8]. Postoperative management must be meticulously carried out to ensure optimal alignment of the hallux [4]. Successful treatment of recurrent hallux valgus requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring joint congruity, and balancing soft tissues [9]. Appropriate treatment for iatrogenic hallux varus requires careful clinical and radiological work-up to identify the causes, and each cause must then be corrected to achieve stable results over time [5]. Third- and fourth-generation minimally invasive surgical techniques are effective in correcting radiographic parameters and improving pain and functional scores in patients undergoing revision for recurrent hallux valgus, with a low rate of complications [11]. Arthroscopic correction of the hallux valgus deformity can achieve good clinical and radiologic results, provided that careful preoperative clinico–radiologic assessment is made to exclude patients contraindicated for the procedure [19].

Anatomy & Pathophysiology

Definition and Etiology

Hallux valgus is defined as the lateral deviation of the proximal phalanx on the first metatarsal head [41], characterized by lateral deviation of the great toe with medial deviation of the first metatarsal [31]. This complex deformity arises from a combination of intrinsic and extrinsic factors. Intrinsic contributors include genetic predisposition, ligamentous laxity, and predisposing anatomy such as a convex metatarsal head or pes planus [31]. Extrinsic factors predominantly involve constricting footwear, specifically high-heeled shoes with a narrow toe box [31, 45]. The etiology is further influenced by a hypermobile first tarsometatarsal joint [45]. Other predisposing factors include rheumatoid or inflammatory arthritis, generalized ligamentous laxity, and dysmorphism of the first metatarsal [45]. Hallux valgus is significantly more common in women than in men, with an incidence 10 times greater in women [41, 56]. The condition is also significantly more prevalent in shod populations than unshod ones [56]. Approximately 70% of patients have a family history of the condition, suggesting a hereditary component [41]. While metatarsus primus varus and pes planus have been implicated in etiology [41], hallux valgus is not associated with chronic tightness of the Achilles tendon or gastrocnemius, increased first ray mobility, bilaterality, or pes planus [56]. The deformity is a dynamic condition, potentially correlating more with motions during weightbearing than with plain static measurements [28]. Consequently, foot alignment changes with loading, necessitating measurement of bone positions in controlled conditions [58].

Pathoanatomy and Biomechanics

The pathoanatomy involves gradual failure of medial supportive structures, including the medial collateral ligament and tibial sesamoid, resulting in a varus position of the first metatarsal [45]. This creates a prominent medial eminence, or "bunion," which is a common source of pain related to shoe wear [45]. As the deformity progresses, valgus deviation at the metatarsophalangeal joint develops [45]. The alignment of the flexor and extensor hallucis longus tendons shifts laterally relative to the joint, exacerbating the deformity [45]. Medial capsular attenuation is a key component, while the proximal phalanx drifts laterally [31]. Plantar-lateral migration of the abductor hallucis causes the proximal phalangeal unit to plantar flex and pronate the hallux [31]. This pronation is amplified by the proximal phalangeal attachment of the adductor hallucis [31]. Stretching of the extensor hood of the extensor hallucis longus occurs, and lateral deviation of the extensor and flexor hallucis longus causes muscular imbalance and deforming forces for valgus progression and pronation [31]. The first metatarsal head moves medially off the sesamoids, increasing the intermetatarsal angle [31]. Pronation leads to rounding of the lateral head of the first metatarsal, which should have a flat contour with no rotational deformity [31]. Rounding of the lateral metatarsal head can be difficult to correct with distal first metatarsal osteotomy and requires rotational osteotomy or first tarsometatarsal arthrodesis [31]. Secondary contracture of the lateral capsule, adductor hallucis, and lateral metatarsal-sesamoid and intermetatarsal ligaments occurs [31]. With chronic deformity, the medial joint capsule becomes attenuated, and the lateral joint capsule becomes contracted [56]. As the metatarsal head is pushed medially, the sesamoids slowly erode the crista, allowing for lateral subluxation of the sesamoids from directly plantar to the first metatarsal [56]. With lateral deviation of the hallux, the extensor and flexor hallucis longus assume a lateral position and contribute to lateral forces on the hallux [56]. In severe deformity, both extrinsic and intrinsic muscles lie lateral to the longitudinal axis of the first metatarsophalangeal joint, further enhancing the deformity [56]. Pronation of the hallux occurs because attenuation of the weakest portion of the capsule (the dorsomedial aspect) allows the abductor hallucis tendon to slide beneath the metatarsal head and rotate the proximal phalanx into a position of pronation [56]. More rapid progression may occur in a small percentage of patients whose first metatarsocuneiform joint demonstrates significant instability [56]. Hallux valgus is a complex deformity of the first ray frequently accompanied by deformity and symptoms in the lesser toes, such as hammertoes and claw toes [45, 64]. If the valgus angle of the first metatarsophalangeal joint exceeds 30 to 35 degrees, pronation of the great toe usually results [64]. With abnormal rotation, the flexion-extension axis of the first metatarsophalangeal joint moves farther plantarward [64]. The adductor hallucis, unopposed by the abductor hallucis, pulls the great toe farther into valgus, stretching the medial capsular ligament and attenuating this structure [64]. The flexor hallucis brevis, flexor hallucis longus, adductor hallucis, and extensor hallucis longus increase the valgus moment at the metatarsophalangeal joint, further deforming the first ray [64]. The sesamoid ridge on the plantar surface of the first metatarsal head (the crista) flattens because of pressure from the tibial sesamoid [64]. With this restraint lost, the fibular sesamoid displaces partially or completely into the first intermetatarsal space [64]. In this situation, the patient bears less weight on the first ray and more on the lesser metatarsal heads, increasing the likelihood of transfer metatarsalgia, calluses, and stress fracture of a lesser metatarsal [64]. The valgus posture of the great toe frequently causes a hammer toe-like deformity of the second toe [64]. The strongest data support lateral deviation of the great toe as the primary deformity in most patients, followed by medial angulation of the first metatarsal, though metatarsus primus varus may be the principal cause in adolescents [64]. After genetic factors and binding, unphysiologically designed footwear is probably the major cause of hallux valgus in modern societies [64]. First tarsometatarsal joint instability increases the maximum transfer of force to the central forefoot, increasing the risk of metatarsalgia [64]. Metatarsal pronation is associated with hallux valgus, with the underlying mechanism generally being cuneometatarsal instability [90]. Rotational instability of the first metatarsophalangeal joint is a major factor in the development of hallux valgus and varus deformities [108]. As the great toe starts to rotate, muscle pulls across the first metatarsophalangeal joint become imbalanced and lead to progressive medial or lateral deviation of the great toe [108]. The medial and lateral metatarsosesamoid suspensory ligaments together with the sesamoid apparatus are the main contributors to the rotational stability of the first metatarsophalangeal joint [108].

Radiographic Assessment

Multiple measurements obtained from standard radiographs guide treatment options for hallux valgus [31]. Diagnostic confirmation is made using standard AP and lateral weight-bearing radiographs, as non-weight-bearing radiographs tend to underestimate the deformity [45]. Radiographs are assessed for the presence of arthritis at the first metatarsophalangeal joint, severity of the deformity determined by the intermetatarsal angle, sesamoid subluxation, and the hallux valgus angle [45]. They are also assessed for first tarsometatarsal hypermobility and congruency of the metatarsophalangeal joint [45]. The hallux valgus angle is the angle formed by a line along the first metatarsal shaft and a line along the shaft of the proximal phalanx, identifying the degree of deformity at the metatarsophalangeal joint [31, 41]. The normal hallux valgus angle is less than 15 degrees [31]. The first-second intermetatarsal angle is the angle formed by lines along the first and second metatarsal shafts [31]. The normal first-second intermetatarsal angle is less than 9 degrees [31]. This angle is not influenced by overresection of the medial eminence and is not accurate for postoperative evaluation of distal osteotomies [41]. The hallux valgus interphalangeus angle is the angle formed by lines along the shafts of the proximal phalanx and distal phalanx [31]. The normal hallux valgus interphalangeus angle is less than 10 degrees and is associated with a congruent deformity [31]. The distal metatarsal articular angle is the angle formed by a line along the articular surface of the first metatarsal and a line perpendicular to the axis of the first metatarsal [31]. It is also defined as the angle of the distal articular surface of the first metatarsal to the long axis of the metatarsal [56]. The normal distal metatarsal articular angle is less than 10 degrees [31, 56], though generally considered to be 10 to 15 degrees [64]. An increased distal metatarsal articular angle is associated with a congruent deformity [31] and is a predisposing factor in the development of hallux valgus [41]. Congruency of the metatarsophalangeal joint is assessed by measuring this angle [45]. A congruent joint has no lateral subluxation of the proximal phalanx in relation to the first metatarsal head, whereas an incongruent joint has lateral subluxation [56]. The proximal phalangeal articular angle has a normal value of less than 10 degrees [41], with a normal range generally considered to be 7 to 10 degrees [64]. Its offset is a predisposing factor in the development of hallux valgus [41]. The first metatarsocuneiform joint angle is based on the distal articular surface of the medial cuneiform and the longitudinal axis of the first metatarsal [56]. Excessive medial deviation of this joint may indicate that hypermobility is present [56]. Arthrosis of the metatarsophalangeal joint is characterized by joint space narrowing, subchondral sclerosis, and osteophyte formation [56]. Increasing evidence indicates that failure to correct the distal metatarsal articular angle can cause unsatisfactory results after surgery in some patients [64]. Hallux valgus angles based on margo medialis pedis measurements were slightly but statistically significantly smaller than metatarsophalangeal angle measurements and should be considered conservative estimates of the metatarsophalangeal angle [46].

Juvenile and Adolescent Pathophysiology

Hallux valgus occurring in the preteen or teenage years is often associated with a smaller medial eminence prominence, increased magnitude of the first-second intermetatarsal angle, increased hypermobility of the first tarsometatarsal joint, less pronation, and a higher recurrence rate with surgical intervention than in the adult cohort [70]. Juveniles are more likely to have bilateral deformities and a family history of hallux valgus [70]. Juvenile hallux valgus occurs more commonly in girls than in boys [88]. The angular deformity is typically less severe in children than in adults, and large medial prominences are rare [88]. A congruent joint with an increased distal metatarsal articular angle is more common in juvenile hallux valgus than in the adult condition [88]. Juvenile hallux valgus is sometimes associated with other deformities, such as metatarsus adductus [88]. Generalized ligamentous laxity may be more common in children with hallux valgus than in the general population [88]. Childhood hallux valgus is mainly due to distal first metatarsal joint surface orientation abnormality, unlike in adults where increased first-second metatarsal angle is the main deformity [51]. The deformity in juvenile hallux valgus is secondary to underlying bony and ligamentous anatomy, which must be addressed to prevent recurrence [52]. Varus of the first metatarsal with a large intermetatarsal angle is commonly present [52]. The distal metatarsal articular angle is typically increased [52]. Hallux valgus interphalangeus may be present [52]. Ligamentous laxity may be present, and a history of Ehlers-Danlos or Marfan syndrome should be elicited [52]. Family history is frequently positive in juvenile patients [52]. Although bunion is rare in children, this troublesome deformity often requires treatment [38]. Adolescent bunion is frequently hereditary, usually seen in early adolescence, and almost always found in conjunction with a wide forefoot caused by varus of the first metatarsal shaft [38]. The wide forefoot allows severe lateral deviation of the great toe, causing the prominent base of the great toe to rub against the inside of the shoe and create a painful bunion [38]. Many adolescent bunions are progressive and require surgical management [38]. There is a fairly high incidence of recurrence of the deformity following surgery for adolescent bunions [38].

Special Populations and Associated Conditions

Hallux valgus deformity in patients with cerebral palsy is usually associated with other deformities, such as equinovalgus foot, heel valgus, and external rotation of the tibia [66]. These conditions cause the foot to pronate, forcing the first metatarsophalangeal joint into abduction and creating a hallux valgus deformity [66]. The extensor hallucis tendon may sublux into the first web space and become an abductor of the hallux, leading to further deformity [66]. Hallux valgus in patients with cerebral palsy develops in response to an equinovalgus deformity of the hindfoot [73]. Spasticity of the peroneus longus leads to progressive eversion and abduction of the foot, resulting in lateralization of the origin of the adductor hallucis muscle and subsequent increasing pull of the proximal phalanx of the great toe into adduction [73]. When combined with external tibial torsion, the toe is pushed laterally as weight is borne by the everted forefoot [73]. The first toe comes to lie beneath the second toe in patients with cerebral palsy and hallux valgus [73]. The head of the first metatarsal becomes uncovered as the toe deviates laterally, and a painful

Classification

Radiographic Severity: Hallux valgus deformity is classified by the preoperative hallux valgus angle (HVA). An HVA of less than 20 degrees is classified as a mild deformity [47]. An HVA of 21 to 40 degrees is classified as a moderate deformity [47]. An HVA of more than 40 degrees is classified as a severe deformity [47].

Pathognomonic Criteria: Specific radiographic parameters are considered pathognomonic for hallux valgus. These include an HVA of 15 degrees, an intermetatarsal angle (IMA) of 9 degrees, a distal metatarsal articular angle (DMAA) of ≥10 degrees, and a hallux valgus interphalangeal angle (HVI) of ≥8 degrees [42].

Other Considerations: Quantitative Indicators: The metatarsophalangeal joint angle (MTPJA) and congruency index (CI) serve as quantitative evaluation indicators for hallux valgus [55]. Clinically, MTP joint congruency should be considered when selecting surgical methods for different degrees of deformity [55].

Perceived vs. Radiographic Severity: A significant discrepancy exists between radiographically-assessed and self-recognized hallux valgus, a gap that narrows as the severity of the deformity progresses [35].

Surgical Indication by Severity: Mild to Moderate Deformity: The chevron osteotomy is a reliable procedure for correcting mild and moderate hallux valgus [7]. Percutaneous distal metatarsal osteotomy is an effective and reliable method for correcting mild-to-moderate deformity [23]. The percutaneous technique is reliable for executing a distal linear osteotomy of the first metatarsal to correct painful mild-to-moderate hallux valgus [39]. Minimally invasive distal linear osteotomy achieves good clinical and radiographic outcomes comparable to open surgical techniques in the management of mild to severe hallux valgus [18]. Distal linear metatarsal osteotomy (DLMO) is an acceptable procedure to correct reducible hallux valgus in most patients with moderate severity [26].

Moderate to Severe Deformity: The combined proximal opening wedge and distal chevron osteotomy is a reliable technique for correcting moderate to severe hallux valgus [21]. Better clinical and radiological outcomes are achieved in patients with moderate to severe deformity when the Lindgren–Turan distal metatarsal osteotomy is combined with transosseous capsuloplasty [29].

Severe Deformity: Proximal osteotomy is a good method for treating severe hallux valgus deformity [14]. The modified Kramer osteotomy can achieve normal angular configuration, even with severe deformities, without significant long-term loss of correction [76].

Clinical Presentation

Definition and Etiology

Hallux valgus is frequently associated with medial deviation of the first metatarsal [41]. Intrinsic factors contributing to the deformity include genetic predisposition, ligamentous laxity, and predisposing anatomy such as a convex metatarsal head or pes planus [31, 32]. Extrinsic factors include specific types of shoewear, particularly narrow toe boxes and high heels [31, 32]. Notably, hallux valgus deformity is not associated with chronic tightness of the Achilles tendon or gastrocnemius, increased first ray mobility, bilaterality, or pes planus [56].

Pathoanatomy

The pathoanatomy of hallux valgus involves medial capsular attenuation [31, 32]. With chronic deformity, the medial joint capsule becomes attenuated while the lateral joint capsule becomes contracted [56]. The proximal phalanx drifts laterally [31, 32]. Pronation leads to rounding of the lateral metatarsal head, which should have a flat contour with no rotational deformity [31, 32]. The prominent medial eminence of the first metatarsal head is a common source of pain related to shoe wear [45]. As the metatarsal head is pushed medially, the sesamoids slowly erode the crista, allowing for lateral subluxation of the sesamoids from directly plantar to the first metatarsal [56].

Symptoms and Signs

The most common symptom is pain over the medial eminence [56]. Patients also complain of joint pain and pain under the second metatarsal head, known as a transfer lesion or metatarsalgia [56]. Common symptoms include pain and a sensation of pressure under the second, and sometimes third, metatarsal head [43]. The deformity may prevent shoewear, and the resulting activity limitation may be part of the symptom constellation [56]. Numbness can occur in the dorsal medial cutaneous nerve distribution due to external pressure from a shoe [45].

Common presenting signs include underlapping and overlapping first and second toes, which cause subluxation or dislocation of the second metatarsophalangeal joint [43]. Pain or callus formation under the second metatarsal head is also a common sign [43].

Physical Examination

A complete evaluation is performed on both lower extremities with the patient undressed from the knees to the toes [56]. The patient is instructed to stand and walk, during which the posture of the foot and the position of the hallux and lesser toes are noted [56]. The severity of the hallux valgus deformity and any associated pes planus are best assessed while the patient is standing [45]. The skin is evaluated for erythema, swelling, ulceration, or callosities [56]. While seated, the first metatarsophalangeal joint area is evaluated for signs of local irritation and bursal hypertrophy secondary to shoe wear [45]. Tenderness over the medial eminence is evaluated during the physical examination [45].

Range of motion is checked for the ankle, subtalar, transverse tarsal, and metatarsophalangeal joints [56]. It is important to note the range of motion of the first metatarsophalangeal joint in both the deformed and corrected position [56]. The amount of motion limitation provides insight into the degree of surgical correction obtainable at the joint without impairing motion [56]. Pain with motion of the first metatarsophalangeal joint may suggest arthritis within the joint [45].

The first tarsometatarsal joint is evaluated for hypermobility, which remains a diagnostic challenge with poor reproducibility [45]. The first metatarsocuneiform joint is examined for hypermobility by stabilizing the medial cuneiform and ranging the first metatarsal dorsomedially and plantolaterally [56]. Pronation of the great toe is easily noted by comparing the angulation of the nail of the great toe in relation to the floor [31, 32].

The neurovascular status of the foot is carefully assessed, noting absent pulses and venous stasis changes [56]. If there is compromise of the vascularity, vascular studies may be obtained [56]. Doppler studies are obtained if there is any question regarding the circulatory status of the foot [56].

Radiographic Evaluation

Weight-bearing radiographs of the foot are important to evaluate the type and severity of the hallux valgus deformity [56]. Radiographs should be assessed for the presence of arthritis at the first metatarsophalangeal joint [45]. Arthrosis of the metatarsophalangeal joint is characterized by joint space narrowing, subchondral sclerosis, and osteophyte formation [56].

Radiographs are assessed for the severity of the deformity as determined by the intermetatarsal angle between the first and second metatarsals [45]. The hallux valgus angle is also assessed [45]. A hallux valgus angle of 15 degrees, an intermetatarsal angle of 9 degrees, a distal metatarsal articular angle of ≥10 degrees, and a hallux valgus interphalangeus angle of ≥8 degrees were considered pathognomonic for hallux valgus [42]. Because hallux valgus angles based on margo medialis pedis measurements were slightly but statistically significantly smaller, these measurements should be considered conservative estimates of the metatarsophalangeal angle [46].

Radiographs are assessed for sesamoid subluxation [45]. The characteristics of the medial eminence are evaluated, especially size, as measured from the sagittal groove [56]. Radiographs are also assessed for first tarsometatarsal hypermobility [45]. Congruency of the metatarsophalangeal joint is assessed by measuring the distal metatarsal articular angle of the first metatarsal [45]. A congruent joint has no lateral subluxation of the proximal phalanx in relation to the first metatarsal head [56]. An incongruent joint has lateral subluxation of the proximal phalanx on the metatarsal head [56]. Clinically, congruency of the metatarsophalangeal joint should be considered when choosing surgical methods for different degrees of hallux valgus [55]. The metatarsophalangeal joint angle and congruency index can be used as quantitative evaluation indicators for congruency [55].

Investigations

Plain radiography: Diagnostic confirmation of hallux valgus requires standard AP and lateral weight-bearing radiographs [45]. Non-weight-bearing radiographs tend to underestimate the deformity [45]. Radiographs are assessed for the severity of the deformity using the intermetatarsal angle and hallux valgus angle, as well as for the presence of arthritis at the first metatarsophalangeal joint [45]. Assessment includes first tarsometatarsal hypermobility and congruency of the metatarsophalangeal joint by measuring the distal metatarsal articular angle [45]. The metatarsophalangeal joint congruency angle and congruency index serve as quantitative evaluation indicators for choosing surgical methods [55]. Hallux valgus is a dynamic condition where deformity may correlate more with motions during weightbearing than with plain static measurements [28]. Weight-bearing radiographs help determine the degree of arthrosis in hallux varus [71].

Radiographic Angles and Measurements: The hallux valgus angle (HVA) is defined as the angle formed by the intersection of lines along the shafts of the first metatarsal and the proximal phalanx [31]. The first–second intermetatarsal angle (IMA) is defined as the angle formed by the intersection of lines along the shafts of the first and second metatarsals [31]. The distal metatarsal articular angle (DMAA) is defined as the angle formed by the line along the articular surface of the first metatarsal and a line perpendicular to the axis of the first metatarsal [31]. The normal distal metatarsal articular angle is less than 15 degrees [41, 45]. The proximal phalangeal articular angle (PPAA) is defined as the articular angle of the base of the proximal phalanx in relation to its longitudinal axis [41]. The normal proximal phalangeal articular angle is less than or equal to 10 degrees [41]. The hallux valgus interphalangeus (HVI) angle is defined as the angle formed by lines along the shafts of the proximal phalanx and distal phalanx [31]. Hallux valgus interphalangeus is associated with a congruent deformity [31]. The first–second intermetatarsal angle is not influenced by overresection of the medial eminence [41]. The first–second intermetatarsal angle is not accurate for postoperative evaluation of distal osteotomies [41]. Hallux valgus angles based on margo medialis pedis measurements are slightly but statistically significantly smaller than metatarsophalangeal angle measurements [46]. Margo medialis pedis measurements should be considered conservative estimates of the metatarsophalangeal angle [46].

Clinical Examination: Tenderness over the medial eminence is evaluated during the clinical examination [45]. Range of motion of the first metatarsophalangeal joint is evaluated during the clinical examination [45]. The amount of motion limitation of the first metatarsophalangeal joint gives insight into the degree of surgical correction that can be obtained without impairing motion [56]. The posture of the foot is noted as well as the position of the hallux and lesser toes [56]. For hallux varus, it must be determined whether the metatarsophalangeal and interphalangeal joint deformities are fixed or passively correctable [71]. The most commonly reported symptom of hallux varus is difficulty with shoe wear because of a prominent interphalangeal joint [71]. Transfer lesions may develop along the lesser metatarsals in hallux varus [71].

Specific Pathology Assessment: Radiographs are assessed for arthrosis of the metatarsophalangeal joint, characterized by joint space narrowing, subchondral sclerosis, and osteophyte formation [56]. The angle of the first metatarsocuneiform joint is based on the distal articular surface of the medial cuneiform and the longitudinal axis of the first metatarsal [56]. The position of the medial sesamoid in relation to a line drawn down the midaxis of the first metatarsal is noted on radiographs [41]. Patients whose postoperative sesamoid is in position 5 to 7 have a much higher recurrence of deformity compared with those with a more medial position for the sesamoid [41].

Treatment

Non-Operative

Non-operative treatment cannot correct the hallux valgus deformity but can help control symptoms [83]. In juvenile and adolescent patients, nonsurgical management should be considered first, especially in those with ligamentous laxity or neuromuscular disorders, due to higher recurrence rates with surgical intervention [70]. For hallux varus, shoe modifications and shoe stretching represent the limited nonoperative treatment options [52].

Operative

Indications: Surgical intervention is indicated when non-operative measures fail to control symptoms. In juvenile and adolescent hallux valgus, single, double, or triple osteotomies are required to correct the deformity, applying the same principles as described for evaluation of adult hallux valgus [52]. Arthrodesis of the metatarsophalangeal joint is appropriate in patients with ligamentous laxity (Ehlers–Danlos syndrome), cerebral palsy, Down syndrome, and rheumatoid arthritis [70]. In patients with cerebral palsy, isolated soft-tissue procedures for hallux valgus rarely are successful and have a high recurrence rate, and great toe metatarsophalangeal joint fusion is recommended [66]. Any other underlying deformities, such as heel valgus or external rotation of the tibia, should be corrected before surgical correction of the hallux valgus in patients with cerebral palsy [66].

Surgical Approach / Technique: Distal metatarsal osteotomies effectively treat mild and moderate hallux valgus deformity. Both modified minimally invasive chevron osteotomy and traditional incision chevron osteotomy yield significantly improved clinical efficacy and imaging results [13]. The minimally invasive distal linear osteotomy achieves good clinical and radiographic outcomes comparable to open surgical techniques in the management of mild to severe hallux valgus deformity, with decreased recovery and rehabilitation times [18]. Distal linear metatarsal osteotomy (DLMO) is an acceptable procedure to correct reducible hallux valgus in most patients with moderate level of severity [26]. Better clinical and radiological outcomes can be achieved in patients with moderate to severe hallux valgus deformity operated by Lindgren–Turan distal metatarsal osteotomy when it is combined with transosseous capsuloplasty [29].

Proximal osteotomy is a good method for treating a severe hallux valgus deformity, with 86% of patients stating the operation was worthwhile after 8 years of follow-up [14]. In cases of ligamentous laxity in juvenile and adolescent hallux valgus, a first tarsometatarsal (TMT) arthrodesis substitutes for a proximal osteotomy to correct the intermetatarsal angle, and the first metatarsal physeal plate must be closed [52].

Minimally invasive and percutaneous techniques produce results similar to conventional surgery for hallux valgus and hallux rigidus [1]. Minimally invasive distal transverse metatarsal osteotomy–Akin osteotomy (MITA) provides effective correction of hallux valgus, achieving excellent radiographic alignment and favorable clinical outcomes [6]. Third- and fourth-generation minimally invasive surgical techniques have proven effective in correcting radiographic parameters and improving pain and functional scores in patients undergoing revision for recurrent hallux valgus, with a low rate of complications [11]. Fourth-generation percutaneous transverse osteotomies demonstrated significant improvement in clinical and radiographic outcomes with a low rate of recurrence in the largest consecutive series of any percutaneous osteotomy technique used to correct hallux valgus deformity [12]. Third-generation minimally invasive chevron and Akin osteotomies (MICA) provided significant improvement in clinical outcome measures at the 2-year follow-up and can be successfully used for correction of a range of hallux valgus deformities with a low rate of symptomatic recurrence [25].

Arthroscopic and soft-tissue procedures include the use of a syndesmosis procedure, which yields satisfactory short-term results, with good clinical and radiological results two years post-operatively [3]. Modified endoscopic distal soft tissue procedure (mEDSTP) and arthroscopic Lapidus arthrodesis for correction of severe hallux valgus is technically demanding and reserved to experienced foot and ankle arthroscopists [75].

Other Considerations: Obesity was not associated with unsatisfactory outcomes after reversed L-shaped osteotomy (ReVeL) for hallux valgus, challenging previous recommendations for preoperative weight loss [16]. Acquired hallux varus in adults is usually a complication of hallux valgus surgery [27]. Causes of acquired hallux varus include overcorrection from bunion surgeries such as the McBride procedure, trauma, and systemic arthritis [27]. The fourth-generation percutaneous transverse osteotomy technique demonstrated a low rate of recurrence in the largest consecutive series of any percutaneous osteotomy technique used to correct hallux valgus deformity [12]. The third-generation minimally invasive chevron and Akin osteotomies (MICA) can be successfully used for correction of a range of hallux valgus deformities with a low rate of symptomatic recurrence [25].

Flexible hallux varus deformity can be corrected with a soft tissue procedure involving release of the abductor hallucis muscle and fascia and transfer of a portion of the extensor hallucis longus or extensor hallucis brevis tendon under the transverse intermetatarsal ligament to the distal metatarsal neck [52]. Fixed hallux varus deformity, deformity with limited first metatarsophalangeal motion, joint pain, or presence of first metatarsophalangeal degenerative joint disease is treated with a first metatarsophalangeal arthrodesis [52].

Postoperative Management and Alignment: The postoperative management of hallux valgus surgery must be meticulously carried out to ensure optimal alignment of the hallux [4]. In patients with large eminences and narrow metatarsals undergoing minimally invasive distal metatarsal osteotomy, complications related to insufficient postoperative fragment contact can be expected [65]. Sufficient hallux valgus correction in patients with small eminences and long metatarsals undergoing minimally invasive distal metatarsal osteotomy is questionable [65].

Secondary Deformities and Ulceration: Hallux valgus deformity can develop after amputation of the second toe in diabetic patients [42]. Interdigital ulcerations can occur on the first or third toe after amputation of the second toe in diabetic patients [42].

Recovery

Other Considerations: The minimally invasive distal linear osteotomy allows for decreased recovery and rehabilitation times compared to open surgical techniques [18]. Male feet undergoing MITA present with worse baseline functional impairment but show greater early functional recovery, with clinical and radiographic outcomes comparable to those of female feet at 1 year [74].

Key Evidence

  • [L5] The procedure is particularly reliable for fifth ray abnormalities and produces results similar to conventional surgery for hallux valgus and hallux rigidus. [1] (10.1016/j.otsr.2013.06.017)
  • [L4] The Austin osteotomy is a safe and effective treatment for mild and moderate hallux valgus deformity. [2] (10.1007/bf00434548)
  • [L4] The short-term results of this surgical procedure for the treatment of hallux valgus are satisfactory, with good clinical and radiological results two years post-operatively. [3] (10.1302/0301-620x.96b4.32193)
  • [L5] The postoperative management must be meticulously carried out to ensure optimal alignment of the hallux. [4] (10.5435/00124635-199501000-00005)
  • [L5] Appropriate treatment for iatrogenic hallux varus requires careful clinical and radiological work-up to identify the causes, and each cause must then be corrected to achieve stable results over time. [5] (10.1016/j.otsr.2019.05.018)
  • [L4] MITA provides effective correction of hallux valgus, achieving excellent radiographic alignment and favorable clinical outcomes. [6] (10.1186/s13018-025-06361-3)
  • [L3] At these two follow-up periods, the chevron osteotomy was found to be a reliable procedure for the correction of mild and moderate hallux valgus deformity, and outcome did not differ on the basis of age. [7] (10.2106/00004623-200010000-00002)
  • [L5] Avoiding this zone is recommended during minimally invasive surgery for hallux valgus. [8] (10.1186/s13018-023-04419-8)
  • [L4] Successful treatment of recurrent hallux valgus requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring joint congruity, and balancing soft tissues. [9] (10.1007/s00402-011-1447-6)
  • [L4] Proximal first metatarsal osteotomy in combination with a lateral soft-tissue procedure is effective in correcting moderate to severe symptomatic hallux valgus deformity with metatarsus primus varus. [10] (10.1007/pl00013769)
  • [L4] Third- and fourth-generation minimally invasive surgical techniques have proven effective in correcting radiographic parameters and improving pain and functional scores in patients undergoing revision for recurrent hallux valgus, with a low rate of complications. [11] (10.1186/s12891-026-09946-z)
  • [L5] This study, which was the largest consecutive series of any percutaneous osteotomy technique used to correct hallux valgus deformity, demonstrated significant improvement in clinical and radiographic outcomes with a low rate of recurrence. [12] (10.2106/jbjs.24.01326)
  • [L3] Both modified minimally invasive chevron osteotomy and traditional incision chevron osteotomy effectively treat mild and moderate hallux valgus deformity with significantly improved clinical efficacy and imaging results. [13] (10.1186/s12891-025-08355-y)
  • [L3] Proximal osteotomy is a good method for treating a severe hallux valgus deformity, with 86% of patients stating the operation was worthwhile after 8 years of follow-up. [14] (10.1007/bf00433994)
  • [L1] The Hohmann and Lapidus operations are good options for correction of a hallux valgus deformity, with similar reliable long-term results. [15] (10.1302/0301-620x.95b9.31560)
  • [L3] Obesity was not associated with unsatisfactory outcomes after ReveL for hallux valgus, challenging previous recommendations for preoperative weight loss. [16] (10.1186/s12891-019-2823-6)
  • [L5] Minimally invasive surgery for juvenile hallux valgus allows another surgery to be done on minimally or undamaged tissues if needed later on. [17] (10.1016/j.otsr.2021.103168)
  • [L5] The minimally invasive distal linear osteotomy allows to achieve good clinical and radiographic outcomes comparable to those obtained with open surgical techniques in the management of mild to severe hallux valgus deformity, with decreased recovery and rehabilitation times. [18] (10.1007/s00402-013-1778-6)
  • [L4] Arthroscopic correction of the hallux valgus deformity can achieve good clinical and radiologic results, provided that careful preoperative clinico–radiologic assessment is made to exclude patients contraindicated for the procedure. [19] (10.1016/j.arthro.2008.03.001)
  • [L4] The combined proximal opening wedge and distal chevron osteotomy is a reliable technique for the correction of moderate to severe hallux valgus, providing strong angular correction with satisfactory clinical outcomes. [21] (10.1302/0301-620x.98b9.35984)
  • [L2] The study shows that percutaneous distal metatarsal osteotomy is an effective and reliable method for correction of a mild-to-moderate hallux valgus deformity. [23] (10.1007/s00402-012-1585-5)
  • [L5] The procedure is indicated for symptomatic hallux valgus recalcitrant to conservative treatment but is contraindicated in cases with bony deformity or where the intermetatarsal space cannot be closed manually. [24] (10.1016/j.eats.2023.04.009)
  • [L4] The third-generation MICA provided significant improvement in clinical outcome measures at the 2-year follow-up and can be successfully used for correction of a range of hallux valgus deformities with a low rate of symptomatic recurrence. [25] (10.2106/jbjs.20.01178)
  • [L4] DLMO is an acceptable procedure to correct reducible hallux valgus in most patients with moderate level of severity. [26] (10.1007/s00402-012-1665-6)
  • [L5] Hallux valgus is a dynamic condition, and the deformity could be more correlated with motions during weightbearing than with plain static measurements. [28] (10.1097/corr.0000000000002265)
  • [L3] Better clinical and radiological outcomes can be achieved in patients with moderate to severe hallux valgus deformity operated by Lindgren–Turan distal metatarsal osteotomy when it combines with transosseous capsuloplasty. [29] (10.1007/s00402-009-0986-6)
  • [L3] There was a significant discrepancy between radiographically-assessed and self-recognized hallux valgus which narrowed with the progressing severity of hallux valgus. [35] (10.1186/s12891-021-04978-z)
  • [L4] The percutaneous technique proved to be reliable for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of a painful mild-to-moderate hallux valgus deformity. [39] (10.2106/jbjs.d.02280)
  • [L3] [42] (10.1186/s13018-023-03577-z)
  • [L3] [43] (10.1097/01.blo.0000191269.50033.ec)
  • [L4] Because the hallux valgus angles based on margo medialis pedis measurements were slightly but statistically significantly smaller, these measurements should be considered conservative estimates of the metatarsophalangeal angle. [46] (10.1186/1471-2474-15-133)
  • [L4] [47] (10.2106/00004623-199274010-00016)
  • [L5] Hallux valgus is a complex deformity influenced by both extrinsic factors, such as constricting footwear, and intrinsic factors, including heredity and foot mechanics. [48] (10.2106/00004623-199606000-00018)
  • [L2] Chevron-Akin double osteotomy is a safe and practicable procedure for the treatment of mild-to-moderate hallux valgus. [49] (10.1007/s00402-011-1385-3)
  • [L3] Childhood hallux valgus is mainly due to distal M1 joint surface orientation abnormality, unlike in adults where increased M1M2 angle is the main deformity. [51] (10.1016/j.otsr.2021.102938)
  • [L3] Clinically, congruency of the MTP joint should be considered when choosing surgical methods for different degrees of hallux valgus, and the MTPJA and CI can be used as quantitative evaluation indicators. [55] (10.1186/s13018-022-03028-1)
  • [Paper] These findings suggest that foot alignment changes with loading, making it important to measure bone positions in controlled conditions. [58] (10.1002/jor.25283)
  • [L5] In patients with large eminences and narrow metatarsals, complications related to insufficient postoperative fragment contact can be expected, while sufficient hallux valgus correction in patients with small eminences and long metatarsals is questionable. [65] (10.1186/s13018-015-0304-7)
  • [L3] Male feet undergoing MITA present with worse baseline functional impairment but show greater early functional recovery, with clinical and radiographic outcomes comparable to those of female feet at 1 year. [74] (10.1186/s12891-026-10023-8)
  • [Paper] This is technically demanding and reserved to experienced foot and ankle arthroscopists. [75] (10.1016/j.eats.2023.06.006)
  • [L3] This technique can achieve normal angular configuration, even with severe deformities, without significant long-term loss of correction. [76] (10.1007/s00402-016-2531-8)
  • [L5] Non-operative treatment cannot correct the deformity but can help control symptoms. [83] (10.1302/2058-5241.1.000005)
  • [L4] The study found metatarsal pronation to be associated with hallux valgus, with the underlying mechanism generally being cuneometatarsal instability. [90] (10.1016/j.otsr.2012.05.005)
  • [L4] [108] (10.1016/j.eats.2024.103290)

See Also

References

[1] Percutaneous forefoot surgery. Orthopaedics & Traumatology: Surgery & Research. 2014. DOI: 10.1016/j.otsr.2013.06.017

[2] Clinical and radiological results after Austin bunionectomy for treatment of hallux valgus. Archives of Orthopaedic and Trauma Surgery. 1996. DOI: 10.1007/bf00434548

[3] The use of a syndesmosis procedure for the treatment of hallux valgus. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b4.32193

[4] Disorders of the First Metatarsophalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 1995. DOI: 10.5435/00124635-199501000-00005

[5] Surgical treatment of iatrogenic hallux varus. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2019.05.018

[6] Outcomes and Complications for Minimally Invasive Distal Transverse Metatarsal Osteotomy–Akin Osteotomy (MITA) for Hallux Valgus: 493 Cases. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06361-3

[7] The Chevron Osteotomy for Correction of Hallux Valgus. The Journal of Bone and Joint Surgery-American Volume. 2000. DOI: 10.2106/00004623-200010000-00002

[8] The potentially dangerous zone of the dorsomedial cutaneous nerve in minimally invasive surgery for hallux valgus: a cadaveric study. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04419-8

[9] Salvage of recurrence after failed surgical treatment of hallux valgus. Archives of Orthopaedic and Trauma Surgery. 2011. DOI: 10.1007/s00402-011-1447-6

[10] Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release. Archives of Orthopaedic and Trauma Surgery. 2000. DOI: 10.1007/pl00013769

[11] Minimally invasive surgery in the correction of recurrent hallux valgus: a case series with 2‑year follow‑up. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09946-z

[12] Fourth-Generation Percutaneous Transverse Osteotomies for Hallux Valgus. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01326

[13] Modified minimally invasive chevron osteotomy versus traditional incision chevron osteotomy. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08355-y

[14] Proximal osteotomy in hallux valgus, long-term results of 167 operated feet. Archives of Orthopaedic and Trauma Surgery. 1997. DOI: 10.1007/bf00433994

[15] Long-term results of the Hohmann and Lapidus procedure for the correction of hallux valgus. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b9.31560

[16] The influence of obesity and gender on outcome after reversed L-shaped osteotomy for hallux valgus. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2823-6

[17] Treatment of hallux valgus in children and adolescents. Orthopaedics & Traumatology: Surgery & Research. 2022. DOI: 10.1016/j.otsr.2021.103168

[18] Role of percutaneous distal metatarsal osteotomy for the management of hallux valgus deformity. Archives of Orthopaedic and Trauma Surgery. 2013. DOI: 10.1007/s00402-013-1778-6

[19] Arthroscopy‐Assisted Correction of Hallux Valgus Deformity. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.03.001

[21] Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b9.35984

[23] Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mild-to-moderate hallux valgus deformity. Archives of Orthopaedic and Trauma Surgery. 2012. DOI: 10.1007/s00402-012-1585-5

[24] Modified Endoscopic Distal Soft Tissue Procedure With Medial Metatarsosesamoid Ligament and Intermetatarsal Ligament Augmentation. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.04.009

[25] Third-Generation Minimally Invasive Chevron and Akin Osteotomies (MICA) in Hallux Valgus Surgery. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.01178

[26] Minimally invasive distal linear metatarsal osteotomy for correction of hallux valgus: a preliminary study of clinical outcome and analytical radiographic results via a mapping system. Archives of Orthopaedic and Trauma Surgery. 2012. DOI: 10.1007/s00402-012-1665-6

[27] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Plate 15.3 Kramer/Barmada Osteotomy of the Base of the Femoral Neck for Slipped Capital Femoral Epiphysis > Distal Metatarsal Osteotomy > Hallux Varus.

[28] Impact of First Metatarsal Hyperpronation on First Ray Alignment: A Study in Cadavers. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002265

[29] Transosseous capsuloplasty improves the outcomes of Lindgren–Turan distal metatarsal osteotomy in moderate to severe hallux valgus deformity. Archives of Orthopaedic and Trauma Surgery. 2009. DOI: 10.1007/s00402-009-0986-6

[31] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > ADULT HALLUX VALGUS.

[32] Miller S Review Of Orthopaedics. ADULT HALLUX VALGUS.

[35] The discrepancy between radiographically-assessed and self-recognized hallux valgus in a large population-based cohort. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-021-04978-z

[38] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 10Pediatric Orthopedic Surgery > 9. Adolescent Bunions (Hallux Valgus).

[39] Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus. The Journal of Bone and Joint Surgery (American). 2005. DOI: 10.2106/jbjs.d.02280

[41] Aaos Comprehensive Orthopaedic Review 3. Disorders of the First Ray > I. Hallux Valgus.

[42] Ulcer occurrence on adjacent toes and hallux valgus deformity after amputation of the second toe in diabetic patients. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03577-z

[43] Surgery for Hallux Valgus with Proximal Crescentic Osteotomy Causes Variable Postoperative Pressure Patterns. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000191269.50033.ec

[45] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Foot and Ankle Reconstruction > Hallux Valgus.

[46] The hallux valgus angle of the margo medialis pedis as an alternative to the measurement of the metatarsophalangeal hallux valgus angle. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-133

[47] Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up.. The Journal of Bone & Joint Surgery. 1992. DOI: 10.2106/00004623-199274010-00016

[48] Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Hallux Valgus†. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199606000-00018

[49] Clinical outcome after Chevron–Akin double osteotomy versus isolated Chevron procedure: a prospective matched group analysis. Archives of Orthopaedic and Trauma Surgery. 2011. DOI: 10.1007/s00402-011-1385-3

[51] Abnormalities in distal first metatarsal joint surface orientation: Distal Metatarsal Articular Angle and Distal Metatarsal-2 Articular Angle. Orthopaedics & Traumatology: Surgery & Research. 2021. DOI: 10.1016/j.otsr.2021.102938

[52] Miller S Review Of Orthopaedics. JUVENILE AND ADOLESCENT HALLUX VALGUS.

[55] Radiographic evaluation of congruency of the first metatarsophalangeal joint in hallux valgus. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03028-1

[56] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 8Foot and Ankle Surgery > 1. Hallux Valgus.

[58] Foot radiographic angle variation as a function of weightbearing magnitude. Journal of Orthopaedic Research. 2022. DOI: 10.1002/jor.25283

[64] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > HALLUX VALGUS (BUNION).

[65] Geometric analysis of indications for minimally invasive distal metatarsal osteotomy in treatment of hallux valgus. Journal of Orthopaedic Surgery and Research. 2015. DOI: 10.1186/s13018-015-0304-7

[66] Campbell S Operative Orthopaedics 4 Volume Set. COMBINED ONE-STAGE CORRECTION OF SPASTIC DISLOCATED HIP > HALLUX VALGUS DEFORMITY.

[70] Orthopaedic Knowledge Update. Congenital Disorders of the Foot* > Juvenile Hallux Valgus.

[71] Aaos Comprehensive Orthopaedic Review 3. Disorders of the First Ray > III. Hallux Varus.

[73] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Pigmented Villonodular Synovitis and Giant Cell Tumor of the Tendon Sheath > Hallux Valigus.

[74] Gender differences in early functional recovery after minimally invasive distal transverse metatarsal osteotomy - Akin Osteotomy (MITA) for hallux valgus: a propensity-matched study of 300 cases. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-10023-8

[75] Modified Endoscopic Distal Soft Tissue Procedure (mEDSTP) and Arthroscopic Lapidus Arthrodesis for Correction of Severe Hallux Valgus. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.06.006

[76] Short- and long-term outcomes following hallux-valgus correction: a modified Kramer osteotomy. Archives of Orthopaedic and Trauma Surgery. 2016. DOI: 10.1007/s00402-016-2531-8

[83] Treatment of hallux valgus deformity. EFORT Open Reviews. 2016. DOI: 10.1302/2058-5241.1.000005

[88] Aaos Comprehensive Orthopaedic Review 3. Disorders of the First Ray > II. Juvenile Hallux Valgus.

[90] Axial rotation of the first metatarsal head in a normal population and hallux valgus patients. Orthopaedics & Traumatology: Surgery & Research. 2012. DOI: 10.1016/j.otsr.2012.05.005

[108] Arthroscopically Assisted Reconstruction of Lateral Metatarsosesamoid Suspensory and Lateral Metatarsophalangeal Collateral Ligaments in the Management of Iatrogenic Hallux Varus Deformity. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103290

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.