Operative Approach to Adult Hallux Valgus Deformity

Principles and Techniques

Glenn G. Shi, MD; Joseph L. Whalen, MD, PhD; Norman S. Turner III, MD; Harold B. Kitaoka, MD


J Am Acad Orthop Surg. 2020;28(10):410-418. 

In This Article

Abstract and Introduction


Hallux valgus deformity is a progressive forefoot deformity consisting of a prominence derived from a medially deviated first metatarsal and laterally displaced great toe, with or without pronation. Although there is agreement that the deformity is likely caused by multifactorial intrinsic and extrinsic factors, the best method of operative management is debated despite the creation of basic algorithms. Our understanding of the deformity and the development of newer techniques is continuously evolving. Here, we review the general orthopaedic principles of operative decision-making and management of hallux valgus deformity.


Hallux valgus deformity occurs because of medial deviation of the first metatarsal and lateral deviation of the great toe, with or without coexisting pronation and subluxation of the metatarsophalangeal joint (MTPJ). The etiology of the deformity is both complex and multifactorial, consisting of intrinsic and extrinsic risk factors. This condition affects 23% of the adult cohort.[1]

For those who fail nonsurgical management, surgical treatment options are diverse with varying reported outcomes. Patients' pathoanatomy, expectations, and radiographic characteristics, and surgeons' familiarity and preferences for specific techniques determine the surgical selection. Surgery is reserved for those who fail nonsurgical management. For this group of patients, our review examines the general orthopaedic principles of operative decision-making and management, including both osteotomies and arthrodesis operations.