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

Disclosures

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

In This Article

Management

Nonsurgical

Evidence shows that nonsurgical management neither corrects nor slows the progression of hallux valgus deformities, although it may reduce the symptoms that are secondary to the deformity, such as medial eminence irritation and second metatarsal transfer lesion. Shoes with wider toe boxes to accommodate the deformity are recommended for those with medial eminence pain. A metatarsal pad or orthotic can alleviate pain from transfer metatarsalgia. Toe spacers or sleeves can reduce the symptoms associated with painful interdigital corns. Hallux valgus–specific braces, orthotics, or toe spacers can help with symptoms but do not reverse the course of the condition.

Operative

When nonsurgical management fails to reduce pain, operative treatment may reduce the deformity and underlying deforming forces to recreate a more balanced MTPJ. Although the severity of the deformity based on radiographic measurements often guides principles of treatment, there are patient factors to consider. Furthermore, the surgeons' training and experience can influence their interpretation of the importance of each deformity and selection of procedure.

No single procedure can be universally applied to all patients with hallux valgus. The guidelines will likely continue to evolve as we gain clarity in our understanding of hallux valgus deformity. Generally, the operations featuring soft-tissue reconstruction are rarely applicable, operations such as osteotomies preserving joint function are desirable, and more severe deformities benefit from surgical treatment at a more proximal level.

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