Treatment of hallux valgus. Distal soft-tissue procedures and proximal metatarsal osteotomy

Correction of the hallux valgus deformity is dependent upon recognition of the specific anatomic deformity, followed by selection of a procedure that addresses the specific deformity. A hallux valgus deformity with a subluxated metatarsophalangeal joint has a soft tissue and bony component, both of which need to be corrected, or a recurrence may result. The distal soft tissue procedure addresses the lateral soft tissue contracture by releasing the adductor hallucis, lateral joint capsule and transverse metatarsal ligament. The capsule is medially elongated and the medial eminence needs to be excised. When metatarsus adductus is present, a proximal metatarsal osteotomy should be carried out to correct the bony deformity. If the intermetatarsal angle is not corrected adequately, a recurrence of the hallux valgus is likely since a soft tissue procedure alone could not be expected to correct the bony deformity created by the increased intermetatarsal angle. Postoperatively the correction needs to be supported with a firm compression dressing for 8 weeks to be sure the corrected alignment is maintained until healing of the soft tissues and osteotomy occurs.