Review of current hallux valgus management options

Hallux valgus is one of the most common forefoot pathologies, with a multifactorial etiology that causes important functional impairment and metatarsalgia. The characteristic deformity originates from a biomechanical imbalance induced by the disruption of first metatarsophalangeal joint alignment and manifests as an abnormal weight transfer on the first ray during walking. Conservative treatment is unable to correct the deformity or stop the evolution of the disease but can distinctly control the symptoms. With time, a myriad of surgical correction techniques have been developed but no definitive surgical treatment algorithm has been generally accepted. Nonetheless, the decision process for choosing the suitable technique must be completed on an individual basis after considering the deformity severity stratification, status of the metatarsophalangeal and tarsometatarsal joints, bone anatomy, and associated comorbidities. In spite of a large variety of surgical options, there are a few main strategies that incorporate these variations: metatarsophalangeal and/or tarsometatarsal joint fusion, metatarsal osteotomies and soft tissue procedures. Nowadays, the surgical management of hallux valgus is dominated by first metatarsal osteotomies performed through open surgery or minimally invasive techniques. Hallux valgus angle has been found to be the single most important parameter for surgical outcome prognostic.