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

Anatomy and Pathophysiology

The normal first MTPJ is an imperfect ball-and-socket joint that allows extension and flexion with limited rotation. Medial, lateral collateral ligaments and the plantar plate converge with the capsule to stabilize the joint for controlled motion during gait. Genetic predisposition with hypermobility, constrictive shoe wear, and female sex have been identified as risk factors for the development of hallux valgus.[2] The development of deformity has been described to proceed in sequential steps, but it may be a concurrent and interdependent process that affects alignment and stability of the first MTPJ such as a congruent MTPJ, abnormal distal metatarsal articular angle (DMAA), unbalanced ligamentous and tendinous constraints, and first tarsometatarsal joint (TMTJ) instability. The medial capsule and collateral ligament attenuate because the first metatarsal head deviates medially, moving away from the second metatarsal and translating medially over the sesamoid mechanism. The proximal phalanx is restrained by the adductor hallucis and plantar support structures. Extensor and flexor hallucis longus tendons become deforming forces on the great toe because they bowstring lateral to the MTPJ. The abductor hallucis may subluxate plantar to the metatarsal head and become an ineffective antagonist to the valgus deforming forces.