Surgical management of the hallux valgus: a current concepts review

Abstract

Hallux valgus (HV) remains among the most prevalent forefoot deformities encountered in orthopaedic practice, characterised by complex multiplanar deformity involving lateral deviation, pronation and associated joint pathology. Its aetiology is multifactorial, encompassing extrinsic factors such as footwear and genetic predisposition, as well as intrinsic biomechanical alterations including ligamentous laxity and abnormal foot architecture. The pathogenesis involves deviations in the first metatarsophalangeal joint (MTPJ) biomechanics, destabilised by a dysfunctional windlass mechanism and contributing to cartilage degeneration, bony prominences and sesamoid subluxation.

Clinical assessment integrates detailed history, physical examination and radiographic evaluation of deformity parameters such as the HV and intermetatarsal angles. Conservative management includes orthoses, exercise therapy, footwear modification, and adjunct modalities, which alleviate symptoms and may delay surgical intervention.

Surgical correction remains the definitive treatment, with over 100 procedures described. Techniques are tailored based on deformity severity, including distal soft tissue procedures, various osteotomies (chevron, scarf, Mitchell, Lapidus) and arthrodesis, each with specific indications, advantages and complications. Recent advancements in minimally invasive surgery (MIS) have shown promising results, including superior deformity correction, reduced pain and quicker recovery, though long-term outcomes are comparable to traditional open techniques.

Comparative studies highlight benefits of MIS but emphasise the importance of surgeon experience and patient-specific factors. Overall, the evolution of surgical techniques offers a wide spectrum of options for halting deformity progression and restoring function, underscoring the importance of individualised treatment strategies guided by deformity severity, radiographic findings and patient preferences.

Level of evidence: 5