Hallux Valgus Correction

Indications

Hallux Valgus, radiograph showing hallux valgus and intermetatarsal angle measurement
Radiograph showing hallux valgus and intermetatarsal angle measurement. Image by Jmarchn from Hellerhoff work, Wikimedia Commons, CC BY-SA 3.0.
  • Painful bunion and shoe wear problems despite footwear changes
  • Surgery is not offered for cosmetic reasons alone
  • Assess for first ray hypermobility, lesser toe deformity and transfer metatarsalgia

Position

  • Supine, ankle or thigh tourniquet
  • Bump under the ipsilateral hip
  • Image intensifier available

Operative Steps

  1. Measure hallux valgus angle, intermetatarsal angle and distal metatarsal articular angle on weight bearing films
  2. Mild to moderate deformity, distal chevron osteotomy
  3. Moderate to severe deformity, scarf or proximal osteotomy
  4. Hypermobile first ray or severe deformity, Lapidus first TMT fusion
  5. Akin osteotomy for residual interphalangeal valgus
  6. Lateral release of adductor hallucis and capsule, preserving the fibular sesamoid
  7. Medial capsulorrhaphy
  8. Normal values are HVA under 15 degrees and IMA under 9 degrees
  9. Minimally invasive distal osteotomy is an alternative in selected patients
  10. Check sesamoid position and joint congruency after correction

Postoperative Care

  • Heel weight bearing in a postoperative shoe for about 6 weeks
  • Radiographs at 6 weeks
  • Return to normal shoes at about 8 to 12 weeks
  • Swelling can last 6 to 12 months

Complications

  • Recurrence
  • Hallux varus from over release
  • Avascular necrosis of the metatarsal head
  • Transfer metatarsalgia and stiffness
  • Malunion with dorsiflexion of the first metatarsal
  • Nonunion, most often after Lapidus fusion
  • Dorsomedial cutaneous nerve injury

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.