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Hallux valgus

87 citationsUpdated Sep 2026

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Overview

Surgical management of hallux valgus requires adaptation to the specific type and severity of the deformity [2]. Reported success rates for surgical intervention range from 80% to 95% [2], although long-term outcomes are often inferior to short- and mid-term expectations [10]. At a mean follow-up of 5.2 years, 25.9% of patients reported dissatisfaction with their results [10]. Meticulous postoperative management is essential to ensure optimal alignment of the hallux [16]. Successful correction in young patients depends on proper case selection, surgical technique, and adequate postoperative management, including patient compliance [11].

A variety of procedures are indicated based on deformity severity. The chevron osteotomy is a reliable option for mild and moderate deformities, with outcomes that do not differ by age [6]. Both modified minimally invasive and traditional incision chevron osteotomies effectively treat mild and moderate cases [14]. The Austin osteotomy is safe and effective for mild to moderate deformity [38]. For moderate to severe symptomatic hallux valgus with metatarsus primus varus, proximal first metatarsal osteotomy combined with a lateral soft-tissue procedure is effective [12]. Proximal osteotomy is a good method for severe deformity, with 86% of patients stating the operation was worthwhile after 8 years of follow-up [31]. The Hohmann and Lapidus operations are good options for correction and have similar reliable long-term results [43].

Minimally invasive and percutaneous techniques offer specific advantages. Percutaneous surgery in children yields short-term clinical and radiographic outcomes comparable to adults, though under-correction remains a concern [1]. Minimally invasive surgery for juvenile hallux valgus preserves tissues for potential future interventions [17]. MITA provides effective correction with excellent radiographic alignment and favorable clinical outcomes [3]. Fourth-generation percutaneous transverse osteotomies demonstrate significant improvement in clinical and radiographic outcomes with a low rate of recurrence [15]. Arthroscopic correction achieves good results provided careful preoperative assessment excludes contraindicated patients [23]. A 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]. Avoiding the potentially dangerous zone of the dorsomedial cutaneous nerve is recommended during minimally invasive surgery [22].

Anatomy & Pathophysiology

Definition and Etiology

Hallux valgus is defined as lateral deviation of the proximal phalanx on the first metatarsal head [39], characterized by lateral deviation of the great toe with medial deviation of the first metatarsal [33]. This complex deformity involves the resultant medially directed pressure exerted against the metatarsal head [56]. The condition is multifactorial, primarily associated with female sex, aging, and mechanical constriction from narrow footwear, which poses a greater risk than high heels [35]. Hallux valgus is more common in women than in men [39], with an incidence 10 times greater in women than in men [56]. It is frequently hereditary, usually seen in early adolescence [42], and 70% of patients have a family history of the condition [39].

Intrinsic factors: Genetic predisposition, ligamentous laxity, and predisposing anatomy such as a convex metatarsal head or pes planus contribute to pathophysiology [33]. Other intrinsic contributors include a hypermobile first tarsometatarsal joint [46], rheumatoid or inflammatory arthritis [46], generalized ligamentous laxity [46], and dysmorphism of the first metatarsal [46]. Hallux valgus is also common in rheumatoid arthritis [71].

Extrinsic factors: Certain types of shoewear, including a narrow toe box and high heels, play a role in pathophysiology [33]. The etiology predominantly involves high-heeled shoes with a narrow toe box [46]. Hallux valgus is commonly related to wearing shoes with a narrow toe box [39]. In people who have never worn shoes, the big toe is in line with the first metatarsal [71].

Contested associations: Hallux valgus is not associated with chronic tightness of the Achilles tendon or gastrocnemius, increased first ray mobility, bilaterality, or pes planus [56]. However, metatarsus primus varus and pes planus have been implicated in the etiology [39]. The deformity is a dynamic condition, potentially more correlated with motions during weightbearing than with plain static measurements [29].

Pathoanatomy and Biomechanics

The pathoanatomy involves gradual failure of medial supportive structures, specifically the medial collateral ligament and tibial sesamoid, resulting in a varus position of the first metatarsal [46]. This creates a prominent first metatarsal head medially, known as the "bunion" [46]. Medial capsular attenuation is a key component [33]. As the deformity progresses, valgus deviation at the metatarsophalangeal joint develops [46], and the proximal phalanx drifts laterally [33].

Tendon and Muscle Imbalance: The alignment of the flexor and extensor hallucis longus tendons shifts laterally relative to the metatarsophalangeal joint, exacerbating the deformity [46]. Lateral deviation of the extensor hallucis longus and flexor hallucis longus causes a muscular imbalance and deforming force for valgus progression and pronation [33]. The flexor hallucis brevis, flexor hallucis longus, adductor hallucis, and extensor hallucis longus increase the valgus moment at the metatarsophalangeal joint [68]. With severe deformity, both extrinsic and intrinsic muscles lie lateral to the longitudinal axis of the first metatarsophalangeal joint, further enhancing the deformity [56].

Pronation and Rotational Deformity: Hallux valgus is a multiplanar deformity where metatarsal pronation has been recognized as a significant component [13]. Metatarsal pronation is associated with cuneometatarsal instability [101]. If the valgus angle exceeds 30 to 35 degrees, pronation of the great toe usually results [68]. Pronation 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 pronation [56]. Plantar-lateral migration of the abductor hallucis causes the proximal phalangeal unit to plantar flex and pronate the hallux [33]. This pronation is amplified by the proximal phalangeal attachment of the adductor hallucis [33].

Capsular and Sesamoid Changes: Secondary contracture of the lateral capsule, adductor hallucis, and lateral metatarsal-sesamoid and intermetatarsal ligaments occurs [33]. With chronic deformity, the medial joint capsule becomes attenuated, and the lateral joint capsule becomes contracted [56]. The adductor hallucis pulls the great toe farther into valgus, stretching the medial capsular ligament and attenuating this structure [68]. The first metatarsal head moves medially off the sesamoids, increasing the intermetatarsal angle [33]. Lateral subluxation of the sesamoids from directly plantar to the first metatarsal occurs with lateral deviation of the hallux [56]. The sesamoids slowly erode the crista as the metatarsal head is pushed medially [56]. The sesamoid ridge on the plantar surface of the first metatarsal head (the crista) flattens because of pressure from the tibial sesamoid [68]. The fibular sesamoid displaces partially or completely into the first intermetatarsal space when the crista flattens [68].

Secondary Effects: The patient bears less weight on the first ray and more on the lesser metatarsal heads when the fibular sesamoid displaces [68]. The valgus posture of the great toe frequently causes a hammer toe-like deformity of the second toe [68]. Secondary pathology and deformity can develop in the lesser toes, such as hammertoes and claw toes, which may be symptomatic [46]. Hallux valgus could be an integral part of the causes of stress fractures of the proximal phalanx of the great toe [28].

Biomechanical Correlates: Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway [51]. Hallux valgus negatively impacts self-reported foot pain, function, concerns about foot appearance, and footwear in otherwise healthy adults [58]. Progressive Distance Mapping suggests subgroup-dependent, progressive associations between plantar fat-pad-anchored distance geometry and hallux valgus severity [80]. In young female adults with hallux valgus, rearfoot valgus angles were positively correlated with the ipsilateral hallux valgus angles [113]. Taiwanese female collegiate students with hallux valgus exhibited normal arches, with plantar loads predominantly concentrated on the medial aspects of both feet [113]. Functional reach was predicted based on the hallux valgus angle in women aged 65 years and older [115]. During the weight-loading process, the first metatarsal-cuneiform joint turns dorsiflexed, supinated, and internally rotated [93].

Radiographic Assessment

Diagnostic confirmation of hallux valgus is made with standard AP and lateral weight-bearing radiographs, as non-weight-bearing radiographs tend to underestimate the deformity [46]. Weight-bearing radiographs are important to evaluate the type and severity of the deformity [56]. Radiographs should be assessed for the presence of arthritis at the first metatarsophalangeal joint, severity of the deformity as determined by the intermetatarsal angle, sesamoid subluxation, and the hallux valgus angle [46]. They are also assessed for first tarsometatarsal hypermobility and congruency of the metatarsophalangeal joint [46]. Arthrosis of the metatarsophalangeal joint is characterized by joint space narrowing, subchondral sclerosis, and osteophyte formation [56].

Key Angles: * Hallux valgus angle: The angle formed by the line along the first metatarsal shaft and the line along the shaft of the proximal phalanx [33]. The normal value is less than 15 degrees [33]. This angle identifies the degree of deformity at the metatarsophalangeal joint [39]. * First-second intermetatarsal angle: The angle formed by lines along the first and second metatarsal shafts [33]. The normal value is less than 9 degrees [33]. This angle is not influenced by overresection of the medial eminence and is not accurate for postoperative evaluation of distal osteotomies [39]. * Hallux valgus interphalangeus angle: The angle formed by lines along the shafts of the proximal phalanx and distal phalanx [33]. The normal value is less than 10 degrees [33]. This angle is associated with a congruent deformity [33]. * Distal metatarsal articular angle: The angle formed by the line along the articular surface of the first metatarsal and the line perpendicular to the axis of the first metatarsal [33]. The normal value is less than 10 degrees [33] or less than 15 degrees [39]. An increased distal metatarsal articular angle is associated with a congruent deformity [33]. The offset of this angle is a predisposing factor in the development of hallux valgus [39]. * Proximal phalangeal articular angle: The normal value is less than 10 degrees [39]. The offset of this angle is a predisposing factor in the development of hallux valgus [39].

Joint Congruency: 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]. The distal metatarsal articular angle may be present more often in patients with juvenile onset of hallux valgus and in males [46]. Hallux valgus angles based on margo medialis pedis measurements were slightly but statistically significantly smaller than metatarsophalangeal angles [82]. Measurements of the hallux valgus angle based on margo medialis pedis should be considered conservative estimates of the metatarsophalangeal angle [82].

Juvenile and Adolescent Pathophysiology

Juvenile hallux valgus occurs more commonly in girls than in boys [75]. The angular deformity is less severe in children than in adults [75], and large medial prominences are rare [75]. A congruent joint with an increased distal metatarsal articular angle is more common in juvenile hallux valgus than in the adult condition [75]. Juvenile hallux valgus is sometimes associated with other deformities, such as metatarsus adductus [75]. Generalized ligamentous laxity may be more common in children with hallux valgus than in the general population [75].

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 [78]. Juveniles are more likely to have bilateral deformities and a family history of hallux valgus [78]. Hallux valgus interphalangeus is more common in juvenile-onset hallux valgus than in adult-onset hallux valgus [9]. The significant correlation between hallux valgus interphalangeus and forefoot abduction-related parameters in juveniles highlights the need for a comprehensive assessment and treatment of combined deformities [9].

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 [42]. 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 [42]. Percutaneous hallux valgus surgery in children yields short-term clinical and radiographic outcomes comparable to those reported in adults, though under-correction remains a concern [1]. Male feet undergoing minimally invasive distal transverse metatarsal osteotomy 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 [79].

Associated Conditions and Variants

Hallux Rigidus: Hallux rigidus is associated with hallux valgus interphalangeus, bilateral involvement in those with a family history, and female gender [44]. It is not associated with elevatus, first ray hypermobility, a long first metatarsal, Achilles tightness, abnormal foot posture, symptomatic hallux valgus, adolescent onset, shoe wear, or occupation [44].

Hallux Varus: Hallux varus is defined as a hallux valgus angle measuring 0 degrees or less [54]. The most common cause is iatrogenic deformity resulting from hallux valgus repair, with an incidence of 2% to 10% [54]. It can be associated with an extension deformity of the metatarsophalangeal joint and flexion of the interphalangeal joint [54]. Supination of the hallux may be seen in hallux varus [54]. Hallux varus may be associated with inflammatory conditions, such as rheumatoid arthritis, or neurologic conditions, such as Charcot-Marie-Tooth disease [54].

Congenital Hallux Varus: Congenital hallux varus can occur in isolation with a normal first metatarsal, where a taut fibrous band runs from the medial side of the great toe to the base of the first metatarsal [32]. It may coexist with other malformations of the foot, such as a longitudinal bracket epiphysis of the first metatarsal or preaxial polydactyly [32]. It is uncommonly part of an underlying skeletal dysplasia, such as diastrophic dwarfism [32]. The explanation is that two great toes originate in utero, but the medial or accessory one fails to develop [98]. The rudimentary medial toe, together with the band of fibrous tissue, acts like a taut bowstring and gradually pulls the more fully developed great toe into a varus position [98].

Cerebral Palsy: Hallux valgus deformity in patients with cerebral palsy is created by conditions that cause the foot to pronate, forcing the first metatarsophalangeal joint into abduction [72]. The extensor hallucis tendon may sublux into the first web space and become an abductor of the hallux in patients with cerebral palsy, leading to further deformity [72]. 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 [72].

Classification

Etiological and Predictive Factors: Hallux valgus is a multifactorial condition primarily associated with female sex, aging, and mechanical constriction from narrow footwear [35]. A decision tree model predicted the presence of hallux valgus based on sex, age, and normalized arch height [97].

Radiographic Severity Thresholds: Preoperative deformity severity is classified by the hallux valgus angle: less than 20 degrees is mild, 21 to 40 degrees is moderate, and more than 40 degrees is severe [135]. Specific radiographic values are considered pathognomonic for the condition: a hallux valgus angle of 15 degrees [45], an intermetatarsal angle of 9 degrees [45], a distal metatarsal articular angle of ≥10 degrees [45], and a hallux valgus interphalangeal angle of ≥8 degrees [45]. In juvenile patients, true hallux valgus is defined by an initial metatarsophalangeal angle of at least 15 degrees or an interphalangeal angle of 9 degrees or more [134].

Manchester Scale: The Manchester scale classifies hallux valgus severity into four categories: no deformity (score = 0), mild deformity (score = 1), moderate deformity (score = 2), and severe deformity (score = 3) [63]. The validity of self-assessment using this scale was evaluated using weighted kappa statistics to determine agreement between examiners and participants [63].

Other Considerations: There is a significant discrepancy between radiographically-assessed and self-recognized hallux valgus, which narrows as severity progresses [25]. Digital photographs provide a convenient and precise assessment tool, avoiding the cost and radiation exposure associated with radiographs [26]. The Chinese version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal scale is recommended for comprehensive clinical assessment in Mainland China [21]. Clinically, congruency of the metatarsophalangeal joint should be considered when choosing surgical methods for different degrees of hallux valgus [92]. The metatarsophalangeal joint angle and congruency index serve as quantitative evaluation indicators [92].

Regarding hallux hyperextension, 44.3% of women with hallux valgus had a first toe extension greater than 30 degrees in the relaxed position [128]. Taking 20 degrees as a reference of normality, mean increases in the neutral position were observed in the left foot: 12 degrees in stage B, 9 degrees in stage C, and 6 degrees in stage D [128]. In the right foot, mean increases were 12, 10, and 7 degrees in stages B, C, and D, respectively [128]. No significant association was found between hallux hyperextension and any stage of hallux valgus according to multinomial logistic regression models [128].

Clinical Presentation

Hallux valgus is the most common pathological condition affecting the great toe and the commonest of foot deformities, with prevalence increasing with advancing age [41, 71]. It is most frequently observed in female patients during their fourth or fifth decades of life [46]. While splaying of the forefoot with varus angulation of the first metatarsal predisposes to lateral angulation of the big toe in shod populations [71], the incidence is significantly higher in shod than unshod populations [56]. Other etiologies include rheumatoid arthritis, connective tissue disorders, and cerebral palsy [39]. Eligibility for knee arthroplasty is associated with an increased risk of acquired hallux valgus [19]. The deformity is not associated with chronic tightness of the Achilles tendon or gastrocnemius, increased first ray mobility, bilaterality, or pes planus [56]. Hallux valgus may contribute to stress fractures of the proximal phalanx of the great toe [28]. A relationship between hallux valgus and patellofemoral pain syndrome has been demonstrated, revealing significant differences in hallux valgus angles between affected and asymptomatic limbs [65].

The pathoanatomy involves medial capsular attenuation, specifically at the dorsomedial aspect, which allows the abductor hallucis tendon to slide beneath the metatarsal head and rotate the proximal phalanx into pronation [33, 56]. As the metatarsal head is pushed medially, sesamoids erode the crista, permitting lateral subluxation from a plantar position [56]. The extensor hallucis longus and flexor hallucis longus assume a lateral position, contributing to lateral forces on the hallux [56]. The deformity consists of lateral deviation and rotation of the hallux, accompanied by a prominence of the medial side of the first metatarsal head, known as a bunion [71]. An overlying bursa and thickened soft tissue are often associated with this prominence [71]. Lateral deviation may lead to overcrowding and over-riding of the lateral toes [71]. More rapid progression may occur in patients with significant instability of the first metatarsocuneiform joint [56].

The most common symptom is pain over the medial eminence, which is a frequent source of discomfort related to shoe wear [46, 56]. Patients also report joint pain and pain under the second metatarsal head, indicative of a transfer lesion or metatarsalgia [56]. The deformity may prevent shoewear, resulting in activity limitation [56]. Numbness can occur in the dorsal medial cutaneous nerve distribution due to external pressure from shoes [46]. Preoperative patient-reported depression and anxiety may affect short-term surgical outcomes in women with hallux valgus [47].

Evaluation begins with noting the patient’s occupation, sports activities, and typical shoewear [56]. 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, allowing observation of foot posture and the position of the hallux and lesser toes [56]. The severity of the deformity and any associated pes planus are best assessed while the patient is standing [46]. While seated, the first metatarsophalangeal joint area is evaluated for signs of local irritation, bursal hypertrophy secondary to shoe wear, and tenderness over the medial eminence [46]. The skin is evaluated for erythema, swelling, ulceration, or callosities [56].

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 positions [56]. The amount of motion limitation provides insight into the degree of surgical correction obtainable without impairing joint motion [56]. Any pain with motion may suggest arthritis within the joint [46]. The neurovascular status of the foot is carefully assessed, noting absent pulses and venous stasis changes [56]. If vascularity is compromised, vascular studies may be obtained, and Doppler studies are performed if there is any question regarding the circulatory status of the foot [56].

The first metatarsocuneiform joint is examined for hypermobility by stabilizing the medial cuneiform and ranging the first metatarsal dorsomedially and plantolaterally [56]. The first tarsometatarsal joint is evaluated for hypermobility, which remains a diagnostic challenge with poor reproducibility [46].

Radiographs are assessed for the presence of arthritis at the first metatarsophalangeal joint, severity of deformity, sesamoid subluxation, and specific angular measurements [46]. The hallux valgus angle (HVA) is the angle formed by lines along the first metatarsal shaft and the proximal phalanx shaft, with a normal value less than 15 degrees [33]. The first–second intermetatarsal angle (IMA) is the angle formed by lines along the first and second metatarsal shafts, with a normal value less than 9 degrees [33]. The hallux valgus interphalangeus (HVI) angle is the angle formed by lines along the proximal and distal phalanx shafts, with a normal value less than 10 degrees; this angle is associated with a congruent deformity [33]. The distal metatarsal articular angle (DMAA) is the angle formed by the articular surface of the first metatarsal and a line perpendicular to its axis, with a normal value less than 10 degrees; an increased DMAA is associated with a congruent deformity [33]. Radiographs are also assessed for first tarsometatarsal hypermobility and congruency of the metatarsophalangeal joint via the DMAA [46]. This metatarsal dysmorphism may be present more often in patients with juvenile onset and in males [46]. The intermetatarsal angle is not influenced by overresection of the medial eminence and is not accurate for postoperative evaluation of distal osteotomies [39]. The offset of the distal metatarsal articular angle and the offset of the proximal phalangeal articular angle are predisposing factors in the development of hallux valgus [39]. Multiple measurements from standard radiographs guide treatment options [33]. The characteristics of the medial eminence, especially size measured from the sagittal groove, are evaluated [56]. Alternative assessment methods provide a convenient and precise tool for evaluating hallux valgus while avoiding the cost and radiation exposure associated with radiographs [26]. Such methods can be recommended for the comprehensive assessment of clinical conditions in patients with hallux valgus deformity in Mainland China [21]. Childhood hallux valgus is mainly due to distal M1 joint surface orientation abnormality, unlike in adults where increased M1M2 angle is the main deformity [66].

Investigations

Plain radiography: Diagnostic confirmation of hallux valgus relies on standard anteroposterior and lateral weight-bearing radiographs, as non-weight-bearing views tend to underestimate the deformity [46]. Weight-bearing imaging assesses first metatarsophalangeal arthritis, deformity severity via the intermetatarsal angle and hallux valgus angle, sesamoid subluxation, first tarsometatarsal hypermobility, and metatarsophalangeal joint congruency [46]. The hallux valgus angle (HVA) is defined by the intersection of lines along the longitudinal axes of the first metatarsal shaft and proximal phalanx shaft [33]. The first–second intermetatarsal angle (IMA) is formed by lines along the shafts of the first and second metatarsals [33]. The hallux valgus interphalangeus (HVI) angle is formed by lines along the shafts of the proximal and distal phalanges [33]. The distal metatarsal articular angle (DMAA) is defined as the angle between a line along the first metatarsal articular surface and a line perpendicular to the first metatarsal axis [33], or alternatively as the angle of a line bisecting the metatarsal shaft with a line through the base of the distal articular cartilage cap [39]. The normal DMAA is less than or equal to 15 degrees [39]. The proximal phalangeal articular angle (PPAA) is the articular angle of the proximal phalanx base relative to its longitudinal axis, with a normal value of less than or equal to 10 degrees [39]. The preoperative HVA is the main radiological predictor for correction, with correction rates declining in patients with a preoperative HVA exceeding 37 degrees due to metatarsophalangeal joint subluxation [107]. HVA measurements based on margo medialis pedis are slightly but statistically significantly smaller than metatarsophalangeal angles and should be considered conservative estimates [82]. The IMA is not influenced by overresection of the medial eminence and is not accurate for postoperative evaluation of distal osteotomies [39].

Ultrasonography: Ultrasonography evaluates first ray hypermobility in symptomatic and asymptomatic patients [114]. Foot width and HVA are associated with first ray hypermobility [114]. Increases in HVA and IMA are associated with symptoms among hallux valgus patients [114].

Other Considerations: Hallux valgus is a dynamic condition where deformity may correlate more with motions during weightbearing than with plain static measurements [29]. Severity and associated pes planus are best assessed while the patient is standing [46]. While seated, the first metatarsophalangeal joint is evaluated for local irritation, bursal hypertrophy secondary to shoe wear, tenderness over the medial eminence, and range of motion [46]. Pain with motion of the first metatarsophalangeal joint may suggest intra-articular arthritis [46]. The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal scale (AOFAS-Hallux-MTP-IP) is recommended for comprehensive clinical assessment in Mainland China [21]. Measurement of the HVA on digital photographs provides a convenient and precise assessment tool while avoiding radiograph cost and radiation exposure [26]. There is a significant discrepancy between radiographically-assessed and self-recognized hallux valgus, which narrows as severity progresses [25]. Hallux valgus deformity and severity are positively associated with the magnitude of anteroposterior postural sway [51]. A significant difference in HVA exists between affected and asymptomatic limbs in patients with patellofemoral pain syndrome [65]. Eligibility for knee arthroplasty is associated with an increased risk of acquired hallux valgus [19]. Childhood hallux valgus is mainly due to distal first metatarsal joint surface orientation abnormality, unlike in adults where an increased first-second metatarsal angle is the main deformity [66]. For hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired, while central rays show indicative differences in instant load distribution rather than peak or cumulative load [124]. Weight-bearing radiographs can help determine the degree of arthrosis in hallux varus [54]. Arthroscopic correction achieves good clinical and radiologic results provided careful preoperative clinico-radiologic assessment excludes contraindicated patients [23]. Augmented reality guided osteotomies can potentially improve accuracy during correction, particularly for less experienced surgeons [127].

Treatment

Non-Operative

Non-operative treatment cannot correct the deformity but can help control symptoms [96]. Nonsurgical management should be considered first in all patients with juvenile hallux valgus, especially those with ligamentous laxity or neuromuscular disorders, because of the higher recurrence rate with surgical intervention [78].

Operative

Indications: Surgical treatment for hallux valgus must be adapted to the type and severity of the deformity, with success rates ranging from 80% to 95% [2]. Reducibility of hallux valgus deformities must be taken into account in the surgical treatment of this entity [40]. Obesity was not associated with unsatisfactory outcomes after reversed L-shaped osteotomy for hallux valgus, challenging previous recommendations for preoperative weight loss [18]. When using a validated outcome score, long-term results after surgery for hallux valgus are worse than expected compared with short- and mid-term outcomes, with 25.9% of patients dissatisfied at a mean follow-up of 5.2 years [10].

Surgical Approach / Technique: Distal metatarsal osteotomy is popular due to its simplicity, low invasiveness, lower complication rate, and shorter rehabilitation period [41]. It has mostly been used for mild to moderate hallux valgus because it can only correct lesser degrees of deformity [41]. The chevron osteotomy is a reliable procedure for the correction of mild and moderate hallux valgus deformity, and outcome did not differ on the basis of age [6]. 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 [14]. Chevron-Akin double osteotomy is a safe and practicable procedure for the treatment of mild-to-moderate hallux valgus [89]. The indications for distal Chevron osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe deformity [41]. Distal chevron osteotomy can achieve a greater degree of correction by the addition of a distal soft-tissue procedure [41]. 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 [90].

Proximal metatarsal osteotomy is recommended for moderate to severe hallux valgus; however, it is a technically more demanding procedure than distal metatarsal osteotomy with a longer incision, longer operation time, and higher rate of complications [41]. 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 [31].

Minimally invasive distal transverse metatarsal osteotomy–Akin osteotomy (MITA) provides effective correction of hallux valgus, achieving excellent radiographic alignment and favorable clinical outcomes [3]. 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 [69]. Percutaneous distal metatarsal osteotomy is an effective and reliable method for correction of a mild-to-moderate hallux valgus deformity [67]. Minimally invasive distal linear metatarsal osteotomy (DLMO) is an acceptable procedure to correct reducible hallux valgus in most patients with moderate level of severity [55]. The SERI technique is effective in treating mild to moderate hallux valgus in terms of relief from symptoms and functional improvement [64]. 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 [7]. 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 [50].

The short-term results of the syndesmosis procedure for the treatment of hallux valgus are satisfactory, with good clinical and radiological results two years post-operatively [5]. 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].

Alignment / Balancing Strategy: Overcorrection of the intermetatarsal angle during proximal metatarsal osteotomy can lead to hallux varus [39]. Dorsiflexion at the osteotomy site during proximal metatarsal osteotomy can result in transfer metatarsalgia [39].

Revision: 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 [8]. 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 [4]. The Lapidus procedure is used as salvage after surgical treatment of hallux valgus [53].

Other Considerations: First metatarsophalangeal joint fusion is recommended for hallux valgus in patients with cerebral palsy because isolated soft-tissue procedures rarely are successful and have a high recurrence rate [72]. First metatarsophalangeal joint fusion has been shown to provide the best overall outcome with functional gains and anatomic correction of the deformity being maintained in patients with cerebral palsy [72]. 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 [72]. If causative deformities are not corrected in patients with cerebral palsy, recurrence of hallux valgus is almost certain, especially if fusion of the first metatarsophalangeal joint is not done [72].

Recurrence rates of up to 50% have been noted with surgical treatment of juvenile hallux valgus [75]. Open physes at the base of the proximal phalanx or first metatarsal may preclude the use of osteotomies or fusion in those areas to avoid growth arrest in juvenile hallux valgus [75]. In the presence of open physes, an increased intermetatarsal angle is corrected with a medial opening wedge cuneiform osteotomy rather than a proximal metatarsal osteotomy or fusion [75]. Increased distal metatarsal articular angle can be addressed with a distal biplanar chevron first metatarsal osteotomy in juvenile hallux valgus [75]. In cases of ligamentous laxity, a first tarsometatarsal arthrodesis substitutes for a proximal osteotomy to correct the intermetatarsal angle; the first metatarsal physeal plate must be closed [76]. Arthrodesis of the metatarsophalangeal joint is appropriate in patients with ligamentous laxity (Ehlers–Danlos syndrome), cerebral palsy, Down syndrome, and rheumatoid arthritis [78]. Although bunion is rare in children, this troublesome deformity often requires treatment and is frequently hereditary, usually seen in early adolescence [42]. Surgery for adolescent bunions must address each aspect of the deformity, including trimming the bunion, correcting the varus angulation of the first metatarsal by osteotomy, and centralizing and balancing the hallux valgus by lengthening the adductor hallucis muscle [42]. There is a fairly high incidence of recurrence of the deformity following surgery for adolescent bunions [42].

Hallux varus is a complication of hallux valgus surgery that was not widely recognized until McBride in 1935 reported its occurrence in 5% of patients treated with his procedure [52]. Incidences of hallux varus after almost all operations for hallux valgus range from 2% to 17% [52]. The main causes for hallux varus after hallux valgus surgery include complete release of the lateral structures combined with excessive plication of the medial capsule, excessive resection of the medial eminence, excision of the fibular sesamoid, release of the lateral head of the flexor hallucis brevis at its insertion, and closure of the intermetatarsal angle to neutral or a negative value [52]. Medial deviation of the great toe is most often an iatrogenic deformity secondary to overcorrection of hallux valgus [76]. Over-resection of the medial eminence, excessive lateral release, and 0-degree or negative intermetatarsal angle are causes of iatrogenic hallux varus [76].

Hallux varus can be classified into two types: static (supple) and dynamic (fixed) [52]. Static hallux varus is asymptomatic and mainly a cosmetic complication where all deformity occurs at the metatarsophalangeal joint in the transverse or frontal plane [52]. Dynamic hallux varus deformity is a multiplanar deformity that often is fixed, symptomatic, and difficult to correct surgically [52]. In dynamic hallux varus, the first metatarsophalangeal joint is hyperextended and the interphalangeal joint is acutely flexed [52]. The most common complaint in dynamic hallux varus is that the toe box of the shoe rubs on the dorsomedial surface of the interphalangeal joint [52]. A keratotic lesion may be present beneath the first metatarsal head in dynamic hallux varus caused by the extended hallux pushing the first metatarsal head plantarward [52]. Lesser toes may develop a hammer deformity and metatarsalgia as the hallux assists less in the stance phase of the gait cycle in dynamic hallux varus [52].

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 [76]. 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 [76]. Suture button augmentation is commonly used with a tendon reconstruction for hallux varus but should not be utilized in isolation [76]. Iatrogenic transfer metatarsalgia is a recognized complication after hallux valgus surgery [81].

Complications

Iatrogenic Deformity and Recurrence

Iatrogenic Hallux Varus: Iatrogenic hallux varus is usually acquired in adults as a complication of hallux valgus surgery [32]. Causes of acquired hallux varus include overcorrection from bunion surgeries such as the McBride procedure, trauma, and systemic arthritis [32]. Successful treatment of 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 [4].

Recurrence Management: An endoscopic soft tissue procedure for correcting recurred hallux valgus deformity is indicated for symptomatic recurrence in high-risk patients to preserve the limb without extensive trauma [74]. The arthroscopic/percutaneous group showed a trend towards less correction of the Hallux valgus angle compared to the open group, potentially due to the initial experience with the technique [57].

Long-Term Outcomes and Dissatisfaction

Dissatisfaction Rates: When using a validated outcome score for the assessment of outcome after surgery for hallux valgus, the long-term results are worse than expected when compared with the short- and mid-term outcomes, with 25.9% of patients dissatisfied at a mean follow-up of 5.2 years [10]. Late complications such as residual deformity and metatarsalgia are the primary causes of unsatisfactory outcomes [73].

Specific Procedure Complications and Risks

Proximal Metatarsal Osteotomy: Proximal metatarsal osteotomy is a technically more demanding procedure than distal metatarsal osteotomy with a longer incision, longer operation time, and higher rate of complications [41].

Other Considerations: The development of hallux valgus and ulcerations on the adjacent toes were correlated following amputation of the second toe in diabetic patients [45].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for the resumption of desk work, driving, or light activities of daily living.

Full activity (months): The provided evidence does not specify a typical month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: Minimally invasive distal linear osteotomy is associated with decreased recovery and rehabilitation times compared to open surgical techniques [69]. No specific protocols regarding physiotherapy phasing, immobilisation duration, weight-bearing progression, or brace removal timing are detailed in the evidence.

Functional milestones: Third-generation minimally invasive chevron and Akin osteotomies (MICA) provide significant improvement in clinical outcome measures at the 2-year follow-up [50]. The syndesmosis procedure yields good clinical and radiological results two years post-operatively [5]. There is no statistically significant difference in clinical outcomes (AOFAS scores) between proximal and distal metatarsal osteotomies for moderate to severe hallux valgus deformity in the short and medium term [105].

Other Considerations: Percutaneous hallux valgus surgery in children yields short-term clinical and radiographic outcomes comparable to those reported in adults, though under-correction remains a concern [1]. Minimally invasive distal transverse metatarsal osteotomy–Akin osteotomy (MITA) achieves excellent radiographic alignment and favorable clinical outcomes [3]. The short-term results of the syndesmosis procedure are satisfactory [5]. The outcome of the chevron osteotomy for mild and moderate hallux valgus did not differ on the basis of age [6]. Third- and fourth-generation minimally invasive surgical techniques are effective in correcting radiographic parameters, improve pain and functional scores, and have a low rate of complications in patients undergoing revision for recurrent hallux valgus [7]. There is a significant correlation between hallux valgus interphalangeus and forefoot abduction-related parameters in juveniles [9]. Hallux valgus deformity is a multiplanar deformity where the rotational component, specifically metatarsal pronation, has been recognized over the past 5 to 10 years and given considerable importance [13]. Modified minimally invasive chevron osteotomy and traditional incision chevron osteotomy both effectively treat mild and moderate hallux valgus deformity with significantly improved clinical efficacy and imaging results [14]. Fourth-generation percutaneous transverse osteotomies demonstrated significant improvement in clinical and radiographic outcomes and a low rate of recurrence [15]. Obesity was not associated with unsatisfactory outcomes after reversed L-shaped osteotomy [18]. 86% of patients stated the operation was worthwhile after 8 years of follow-up following proximal osteotomy for severe hallux valgus [31]. Third-generation MICA can be successfully used for correction of a range of hallux valgus deformities with a low rate of symptomatic recurrence [50]. The arthroscopic/percutaneous group showed a trend towards less correction of the Hallux valgus angle compared to the open group [57]. 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 [69]. Late complications such as residual deformity and metatarsalgia are the primary causes of unsatisfactory outcomes after distal first metatarsal displacement osteotomy [73]. Male feet undergoing MITA present with worse baseline functional impairment but show greater early functional recovery, with clinical and radiographic outcomes comparable between male and female feet at 1 year [79]. There is no statistically significant difference in radiological outcomes (IMA, HVA) between proximal and distal metatarsal osteotomies for moderate to severe hallux valgus deformity in the short and medium term [105].

Key Evidence

• [L3] Percutaneous hallux valgus surgery in children yields short-term clinical and radiographic outcomes that are comparable to those reported in adults, though under-correction remains a concern. [1] (10.1016/j.otsr.2013.02.003)
• [L5] Surgical treatment for hallux valgus must be adapted to the type and severity of the deformity, with success rates ranging from 80% to 95%. [2] (10.1302/2058-5241.1.000015)
• [L4] MITA provides effective correction of hallux valgus, achieving excellent radiographic alignment and favorable clinical outcomes. [3] (10.1186/s13018-025-06361-3)
• [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. [4] (10.1016/j.otsr.2019.05.018)
• [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. [5] (10.1302/0301-620x.96b4.32193)
• [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. [6] (10.2106/00004623-200010000-00002)
• [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. [7] (10.1186/s12891-026-09946-z)
• [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. [8] (10.1007/s00402-011-1447-6)
• [L3] The significant correlation between HIA and forefoot abduction-related parameters in juveniles highlights the need for a comprehensive assessment and treatment of combined deformities in managing juvenile-onset hallux valgus. [9] (10.1186/s13018-024-05408-1)
• [L3] When using a validated outcome score for the assessment of outcome after surgery for hallux valgus, the long-term results are worse than expected when compared with the short- and mid-term outcomes, with 25.9% of patients dissatisfied at a mean follow-up of 5.2 years. [10] (10.1302/0301-620x.97b2.34891)
• [L4] Successful hallux valgus correction in young patients depends on proper case selection, surgical technique, and adequate postoperative management including patient compliance. [11] (10.1007/bf00434002)
• [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. [12] (10.1007/pl00013769)
• [L4] Hallux valgus deformity is a multiplanar deformity where rotational component, specifically metatarsal pronation, has been recognized over the past 5 to 10 years and given considerable importance. [13] (10.5435/jaaosglobal-d-20-00091)
• [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. [14] (10.1186/s12891-025-08355-y)
• [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. [15] (10.2106/jbjs.24.01326)
• [L5] The postoperative management must be meticulously carried out to ensure optimal alignment of the hallux. [16] (10.5435/00124635-199501000-00005)
• [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)
• [L3] Obesity was not associated with unsatisfactory outcomes after ReveL for hallux valgus, challenging previous recommendations for preoperative weight loss. [18] (10.1186/s12891-019-2823-6)
• [L2] Our study supports the increased risk of acquired hallux valgus in patients eligible for knee replacement. [19] (10.1186/s12891-024-07458-2)
• [L4] It can be recommended for the comprehensive assessment of the clinical conditions of patients with hallux valgus (HV) deformity in Mainland China. [21] (10.1186/s13018-025-06196-y)
• [L5] Avoiding this zone is recommended during minimally invasive surgery for hallux valgus. [22] (10.1186/s13018-023-04419-8)
• [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. [23] (10.1016/j.arthro.2008.03.001)
• [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)
• [L3] There was a significant discrepancy between radiographically-assessed and self-recognized hallux valgus which narrowed with the progressing severity of hallux valgus. [25] (10.1186/s12891-021-04978-z)
• [L3] This method provides a convenient and precise tool in assessment of hallux valgus, while avoiding the cost and radiation exposure associated with radiographs. [26] (10.2519/jospt.2012.3841)
• [L4] [28] (10.1177/0363546503258780)
• [L5] Hallux valgus is a dynamic condition, and the deformity could be more correlated with motions during weightbearing than with plain static measurements. [29] (10.1097/corr.0000000000002265)
• [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. [31] (10.1007/bf00433994)
• [L2] HV is a multifactorial condition primarily associated with female sex, aging, and mechanical constriction from narrow footwear, which poses a greater risk than high heels. [35] (10.1186/s12891-026-10054-1)
• [L4] The Austin osteotomy is a safe and effective treatment for mild and moderate hallux valgus deformity. [38] (10.1007/bf00434548)
• [L3] Reducibility of hallux valgus deformities must be taken into account in the surgical treatment of this entity. [40] (10.1016/j.otsr.2013.01.009)
• [L1] [41] (10.1302/0301-620x.97b2.34449)
• [L1] The Hohmann and Lapidus operations are good options for correction of a hallux valgus deformity, with similar reliable long-term results. [43] (10.1302/0301-620x.95b9.31560)
• [L3] [45] (10.1186/s13018-023-03577-z)
• [L3] The study suggests that preoperative patient-reported depression and anxiety may affect short-term surgical outcomes in women with hallux valgus. [47] (10.1186/s13018-026-06968-0)
• [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)
• [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. [50] (10.2106/jbjs.20.01178)
• [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. [51] (10.1186/s12891-021-04385-4)
• [L4] DLMO is an acceptable procedure to correct reducible hallux valgus in most patients with moderate level of severity. [55] (10.1007/s00402-012-1665-6)
• [L3] The Arthroscopic/percutaneous group showed a trend towards less correction of the Hallux valgus angle compared to the open group, potentially due to the initial experience with the technique. [57] (10.1016/j.arthro.2023.01.053)
• [L4] Hallux valgus negatively impacts self-reported foot pain, function, concerns about foot appearance, and footwear in otherwise healthy adults. [58] (10.1186/1471-2474-13-197)
• [L2] [63] (10.1186/1471-2474-11-215)
• [Paper] The SERI technique is effective in treating mild to moderate hallux valgus in terms of relief from symptoms and functional improvement. [64] (10.1007/s00264-013-1980-8)
• [L3] This study is the first to demonstrate a relationship between hallux valgus and patellofemoral pain syndrome, revealing a significant difference in hallux valgus angles between the affected and asymptomatic limbs. [65] (10.1007/s00167-009-0775-3)
• [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. [66] (10.1016/j.otsr.2021.102938)
• [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. [67] (10.1007/s00402-012-1585-5)
• [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. [69] (10.1007/s00402-013-1778-6)
• [Paper] This technical note describes an endoscopic soft tissue procedure for correcting recurred hallux valgus deformity, which is indicated for symptomatic recurrence in high-risk patients to preserve the limb without extensive trauma. [74] (10.1016/j.eats.2016.10.022)
• [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. [79] (10.1186/s12891-026-10023-8)
• [L4] Progressive Distance Mapping (PDM) suggests subgroup-dependent, progressive associations between plantar fat-pad-anchored distance geometry and hallux valgus severity. [80] (10.1186/s13018-025-06587-1)
• [L5] [81] (10.1530/eor-22-0043)
• [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. [82] (10.1186/1471-2474-15-133)
• [L2] Chevron-Akin double osteotomy is a safe and practicable procedure for the treatment of mild-to-moderate hallux valgus. [89] (10.1007/s00402-011-1385-3)
• [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. [90] (10.1302/0301-620x.98b9.35984)
• [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. [92] (10.1186/s13018-022-03028-1)
• [L4] During weight-loading process, the first metatarsal-cuneiform joint turns dorsiflexed, supinated, and internally rotated. [93] (10.1186/s13018-015-0289-2)
• [L5] Non-operative treatment cannot correct the deformity but can help control symptoms. [96] (10.1302/2058-5241.1.000005)
• [L4] The decision tree model predicted the presence of hallux valgus on the basis of sex, age, and normalized arch height. [97] (10.1186/s12891-023-06389-8)
• [L4] The study found metatarsal pronation to be associated with hallux valgus, with the underlying mechanism generally being cuneometatarsal instability. [101] (10.1016/j.otsr.2012.05.005)
• [L1] The meta-analysis found no statistically significant difference in clinical outcomes (AOFAS scores) or radiological outcomes (IMA, HVA) between proximal and distal metatarsal osteotomies for moderate to severe hallux valgus deformity in the short and medium term. [105] (10.1007/s00264-018-3782-5)
• [L1] The preoperative HVA is the main radiological predictor for correction of hallux valgus, with correction rates declining in patients with HVA exceeding 37 degrees due to subluxation of the MTPJ. [107] (10.1186/1471-2474-9-70)
• [L4] Taiwanese female collegiate students with hallux valgus exhibited normal arches, with plantar loads predominantly concentrated on the medial aspects of both feet, and their rearfoot valgus angles were positively correlated with the ipsilateral hallux valgus angles. [113] (10.1186/s12891-025-09372-7)
• [L3] Width of the feet and hallux valgus angle were associated with hypermobility of the first ray while an increase in the hallux valgus angle and the first–second intermetatarsal angle were associated with symptoms among hallux valgus patients. [114] (10.1186/s13018-025-05856-3)
• [L4] Functional reach was predicted based on the hallux valgus angle, whereas the five-repetition sit-to-stand, maximal step length, and walking time were predicted based on toe flexor strength. [115] (10.1186/s12891-022-05962-x)
• [L3] For hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired, while central rays show indicative differences in instant load distribution rather than peak or cumulative load. [124] (10.1186/s13018-017-0622-z)
• [L5] This pilot-study suggests that AR guided osteotomies can potentially improve accuracy during hallux valgus correction, particularly for less experienced surgeons. [127] (10.1186/s12891-020-03373-4)
• [L4] [128] (10.1186/s12891-024-07219-1)
• [L4] [134] (10.2106/00004623-199274090-00010)
• [L4] [135] (10.2106/00004623-199274010-00016)

See Also

• Hallux rigidus

References

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