Surgery for hallux varus

NewsBot · Jun 21, 2008

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A new surgical procedure for iatrogenic hallux varus: reverse transfer of the abductor hallucis tendon: a report of 7 cases.
Leemrijse T, Hoang B, Maldague P, Docquier PL, Devos Bevernage B.
Acta Orthop Belg. 2008 Apr;74(2):227-34.

Iatrogenic hallux varus is a possible complication of hallux valgus surgery following Mc Bride or Scarf osteotomy, with or without Akin osteotomy of the first phalanx. It may also occur following chevron osteotomy or Keller's procedure. One possibility for surgical revision of iatrogenic hallux varus is reconstruction of the lateral stabilising soft-tissue components of the first metatarsophalangeal joint. Until now, only dynamic tendon transfers, possibly combined with interphalangeal fusion, have been described. The aim of our study was to develop a static, anatomic reconstruction procedure. A new surgical technique of ligamentoplasty using the abductor hallucis tendon is described. The new method was applied in 7 feet (5 patients) with a mean follow-up over two years. Hallux varus deformities were operated by transplantation of the abductor hallucis tendon. Subsequent radiographs showed correction of most of the factors considered to be responsible for the iatrogenic deformity. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score improved from 61 to 88. This new technique is a reliable, anatomic reconstruction with use of the tendon involved in the pathogenesis of the hallux varus deformity. No other functional tendon is used.
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NewsBot · Feb 15, 2011

The combined reverse scarf and opening wedge osteotomy of the proximal phalanx for the treatment of iatrogenic hallux varus.
Kannegieter E, Kilmartin TE.
Foot (Edinb). 2011 Feb 10. [Epub ahead of print]

BACKGROND: : Hallux varus is a complication of hallux valgus surgery. Historically the standard treatment has been to arthrodese the first metatarso-phalangeal (MTP) joint. More recently other options have come to light, including reverse osteotomies and tendon-transfer procedures.

OBJECTIVES: : This paper presents a small retrospective audit of patients who developed hallux varus following the combined rotation scarf and Akin osteotomy for hallux valgus, and their subsequent treatment with a stepwise approach of soft tissue release and ultimately reverse scarf osteotomy and opening wedge osteotomy of the proximal phalanx.

METHOD: : Five patients attended for a retrospective audit including reasons for revision surgery, review of intermetatarsal (IM) and first metatarso-phalangeal joint (MTPA) angles, AOFAS scores and patient satisfaction.

RESULTS: : At a mean follow up of 38 months, mean IM angle and MTP joint angle improved from 5 to 9° and -10° to 11° respectively. Mean first MTP joint dorsiflexion and plantarflexion was 26° and 19° respectively. One patient was completely satisfied and four were satisfied with reservations with their surgical outcome and 100% felt they were better off as a result of their surgery.

CONCLUSION: : The stepwise approach to the reverse scarf and opening wedge osteotomy of the proximal phalanx for iatrogenic hallux varus is an alternative to first MTP joint arthrodesis for those with a viable joint.
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NewsBot · Dec 27, 2011

Failure after Soft-tissue Release with Tendon Transfer for Flexible Iatrogenic Hallux Varus: A Systematic Review.
Plovanich EJ, Donnenwerth MP, Abicht BP, Borkosky SL, Jacobs PM, Roukis TS.
J Foot Ankle Surg. 2011 Dec 23.

Hallux valgus is a common forefoot pathology often requiring surgical intervention for symptomatic relief. One complication of hallux valgus correction is flexible hallux varus. Iatrogenic flexible hallux varus often requires surgical repair; however, the most advantageous surgical procedure for repair of iatrogenic flexible hallux varus and their sustainability remains unclear. Therefore, we performed a systematic review to determine the sustainability of soft-tissue release with tendon transfer for the correction of iatrogenic flexible hallux varus. Studies were eligible for inclusion only if they involved failure of soft-tissue release with tendon transfer for flexible iatrogenic hallux varus. Eight studies met our inclusion criteria, seven of which were evidence-based medicine level IV studies and one was level V. A total of 52 patients, all female, involving 68 feet, were included. All studies included soft-tissue release of the first metatarsal-phalangeal joint capsule and 1 of the following procedures: Johnson transfer of the extensor hallucis longus tendon with arthrodesis of the hallux interphalangeal joint (41 feet); Hawkins transfer of the abductor hallucis tendon (9 feet); reverse Hawkins transfer (7 feet); Valtin transfer of the first dorsal interosseous tendon (7 feet); and Myerson transfer of the extensor hallucis brevis tendon (4 feet). The weighted mean age of the patients was 50.4 years, and the weighted mean follow-up was 30.2 months. A total of 11 complications (16.2%) occurred. Of note, only 3 cases (4.4%) of recurrent hallux varus deformity developed, all of which occurred after Johnson transfer of the extensor hallucis longus tendon, with arthrodesis of the hallux interphalangeal joint. Our results support that sustainable correction of iatrogenic flexible hallux varus can be achieved with soft-tissue release of the first metatarsal-phalangeal joint combined with a variety of tendon transfer procedures. However, given the limited data available, potential areas for additional prospective investigation remain.
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NewsBot · Dec 4, 2014

Radiographic Results After Hallux Metatarsophalangeal Joint Arthrodesis for Hallux Varus
Lauren E. Geaney, Mark S. Myerson
Foot & Ankle International December 3, 201

Background: Hallux metatarsophalangeal (MP) joint arthrodesis for hallux varus is generally reserved for severe deformity, failed surgery or the development of osteoarthritis. The purpose of this study was to determine the radiologic results of arthrodesis of the hallux MP joint following treatment for hallux varus. Our hypothesis was that in the process of correcting the hallux valgus angle, the 1-2 intermetatarsal angle (1-2 IMA) and hallux valgus angle (HVA) will be improved due to correction of the deforming forces.
Methods: A retrospective review was performed on 26 patients with 29 feet that had symptomatic hallux varus deformities treated with arthrodesis of the hallux MP joint between September 1, 2002, and December 31, 2012. The 1-2 IMA and HVA were measured on the preoperative and most recent postoperative films and compared. Twenty-nine patients were followed with postoperative weight-bearing radiographs. Two were men and 24 were women. Twelve were performed on the right foot, 17 on the left, including 3 bilateral cases. Fourteen patients had concomitant procedures on the ipsilateral forefoot.
Results: The average 1-2 IMA changed from 4.8 degrees to 8.4 degrees, a difference of 3.6 degrees (P < .05), and the average HVA changed from −20.7 degrees to 8.1 degrees (P < .05).
Conclusion: Our study showed that a hallux MP joint arthrodesis in patients with hallux varus resulted in a predictable increase in the 1-2 IMA.
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NewsBot · Aug 27, 2015

Arthroscopic First Metatarsophalangeal Arthrodesis for Repair of Fixed Hallux Varus Deformity
Tun Hing Lui, MBBS (HK), FRCS (Edin), FHKAM, FHKCOS
JFAS; Article in Press

Arthroscopic first metatarsophalangeal arthrodesis for fixed hallux varus deformity can be very difficult because narrowing of the medial joint space results in difficult access. The abductor hallucis tendon and the medial capsule can be released through a small proximal plantar medial incision. This will convert the deformity into a flexible one and open up the medial joint space. This allows arthroscopic arthrodesis using the standard dorsolateral and medial portals. The plantar medial incision can also be used for arthroscopy of the metatarsosesamoid compartment and insertion of a screw for first metatarsophalangeal arthrodesis.
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NewsBot · Sep 18, 2019

Surgical treatment of iatrogenic hallux varus.
Leemrijse T, Devos Bevernage B
OrthopTraumatol Surg Res. 2019 Sep 11

Iatrogenic hallux varus is a dreaded complication of hallux valgus surgery, consisting in 1st-ray deformity in the form of medial malalignment of the 1st phalanx with respect to the metatarsal axis. Such over-correction results from imbalance between excessive medial capsule retraction or tensioning and excessive lateral laxity or soft-tissue release. There may be loss of medial stability of bone origin due to excessive "exostosectomy" or excessive intermetatarsal angle closure. Following excessive lateral release, the imbalance gradually induces a varus deformity of the 1st phalanx due to traction by the medial muscles: abductor hallucis and medial head of flexor hallucis brevis inserting to the medial sesamoid. The deformity comprises 3 components, of varying importance: medial deviation of the hallux at the 1st metatarsophalangeal joint, supination of the phalanx, and interphalangeal flexion (i.e., claw deformity of the hallux). Treatment strategy is determined by the various clinical and radiological data explaining the postoperative hypercorrection. The clinical analysis is decisive, while radiology contributes more technical factors once the treatment option has been decided on. There are two main options for surgical revision to restore 1st ray propulsion: 1) static or dynamic reconstruction of the ligamentous structures, conserving metatarsophalangeal motion; or 2) metatarsophalangeal and/or interphalangeal fusion. Factors guiding choice are mainly range of motion, and reducibility of the metatarsophalangeal and interphalangeal deformity. We describe the procedures in detail, emphasizing the essential points for success. Joint sparing is to be sought in flexible deformities and young patients. Ligament reconstruction can be anatomic or palliative by tenodesis effect, which makes adjustment difficult. Alongside soft-tissue reconstruction, the metatarsal osteotomy should also be revised if the intermetatarsal angle has been unduly closed. Metatarsophalangeal fusion is the most reliable solution and is unavoidable if the joint is stiff or degenerative; it undoubtedly reduces risk of failure.
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NewsBot · Oct 22, 2019

Long term clinical results of hallux varus correction by a reversed abductor hallucis transfersstarf;
KarolienSchwagtenaGeoffroyVandeputtebJohanSomvilleaEmmanuelVan oeckecKristiaanBuedtsd
Foot and Ankle Surgery; 21 October 2019

Highlights
•The currently most favorable technique for the correction of hallux varus is a reverse abductor hallucis tendon transfer.
•There is a success satisfaction rate of 69%, which is significantly correlated with alignment.
•Initial good short term results are no guarantee for successful long term results, and loss of alignment of 31% is possible on a term of 8 years.
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Background
Iatrogenic hallux varus is a rare complication after hallux valgus surgery. Operative treatment comprises a wide variety of techniques, of which the reversed transfer of the abductor hallucis tendon is the most recent described technique.

Methods
This paper will present the long-term clinical results of the reversed transfer of the abductor hallucis longus. Therefore, we performed a prospective clinical observational study on 16 female patients. Our hypothesis is that the tendon transfer will persist in a good alignment and patient satisfaction on long term. There is a 100% follow-up rate with a range from 10 to 101 months. Patients were subjected to a clinical examination, three questionnaires and their general satisfaction.

Results
Out of 16 patients, at time of follow-up, we found a positive correlation between the subjective outcome score and alignment (r = 0.59), and between the general satisfaction and alignment (r = 0.77). Based on the general satisfaction we achieved a success satisfaction rate of 69% (11 patients). The other 31% (5 patients) patient group was only satisfied with major reservations or not satisfied at all. The two most invalidating complications were a coronal or sagittal malalignment or the combination of both.

Conclusion
Our results suggest that the reverse abductor hallucis tendon transfer is a good technique to treat a supple iatrogenic hallux varus with an observed success satisfaction rate of 69% at a mean follow-up time of 48 (range 10-101) months. However, patients should be informed that on the long-term loss of correction is possible.
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NewsBot · Jul 23, 2021

Postoperative Hallux Varus Treatment by Reverse Scarf Osteotomy
Christophe Piat et al
Foot Ankle Int. 2021 Apr 19

Background: Postoperative hallux varus is often accompanied by an abnormal decrease in the first-second (M1M2) intermetatarsal angle, which we have sought to correct by a reverse scarf-type osteotomy.

Methods: A series of 36 hallux varus operated on by reverse scarf osteotomy, including 14 with prior osteotomies, was reviewed with an average follow-up of 56 months. The measurements were clinical: American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) pain score, subjective satisfaction index, joint mobility, and radiologic angles: M1M2 and first metatarsophalangeal angle.

Results: The M1M2 angle increased on average from 3 to 8 degrees whereas the average M1P1 angle of varus went from -21 to +9 degrees, including 2 patients who had a reoccurring valgus of 20 degrees. The median AOFAS score increased from 47 to 79, the VAS from 6.7 to 2.3, joint mobility lost an average of 9 degrees, and all those operated on were satisfied with the result. All operated bones healed without secondary displacement.

Discussion: The reverse scarf osteotomy is capable of correcting the intermetatarsal angle and at the same time correcting the postoperative hallux varus. Functional scores generally improved, including in patients with a reoccurring valgus and those with reduced mobility.

Conclusion: The reverse scarf osteotomy can be performed to treat postoperative hallux varus with a mild intermetatarsal angle with reasonable clinical and radiologic results.
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NewsBot · Oct 4, 2021

Hallux varus: A literature review
RahulMohan et al
The Foot; 23 September 2021, 101863

Highlights
•Hallux varus is a rare foot deformity caused by iatrogenic, post-traumatic, idiopathic, inflammatory, spontaneous and congenital pathologies. Among these iatrogenic is the most common.
•Hallux varus is caused by abnormal musculotendinous forces secondary to soft tissue or bony imbalance exerting a varus deforming force.
•Understanding the anatomy of the hallux stabilisers and the pathophysiology of hallux varus is vital in its management.
•It is also essential to understand the potential surgical pitfalls leading to iatrogenic hallux varus to avoid its occurrence.
Hallux varus is a rare foot deformity due to iatrogenic, post-traumatic, idiopathic, inflammatory, spontaneous, or congenital pathologies. Acquired hallux varus, in particular, iatrogenic type, is the commonest. The primary pathology is the abnormal musculotendinous forces secondary to soft tissue or bony imbalance exerting varus deforming force. Understanding the anatomy of the hallux stabilisers and the pathophysiology of hallux varus is vital in its management. It would be helpful to understand the potential surgical pitfalls leading to iatrogenic hallux varus. This literature review summarises all the published facts about hallux varus, focussing on anatomy, pathophysiology, clinical and radiological assessment, and management.
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NewsBot · Oct 8, 2021

Post-operative hallux varus: a review of treatment methods
Christophe Piat, Cyrille Cazeau & Yves Stiglitz
International Orthopaedics volume 45, pages2193–2199 (2021)

Purpose
Hallux varus is a classical complication of hallux valgus surgery with a medium rate of 6%.

Material and methods
Methods of treatment are MTP1 fusion or conservative joint operations. Hallux varus results from imbalance between excessive medial capsule retraction or tensioning and excessive lateral laxity or soft-tissue release but also and mainly from an over displacement of the first metatarsal which reduces the intermetatarsal angle and thus leads to medial displacement of the great toe. A majority are well tolerated, but few need to be re-operated upon.

Results
Factors guiding choice are mainly range of motion and reducibility of the first metatarsophalangeal joint and tendon balance. Joint sparing could be decided for a mobile and well balancesd MTP1 with two options, soft-tissue repairing such as tendon and ligament transfer and reverse osteotomies. The choice depends mainly on the radiological features as an unduly closed intermetarsal angle which leads to a reverse scarf or chevron osteotomy whatever previous surgery was or was not with an osteotomy.

Conclusion
Conservative treatment is tricky, and MTP1 fusion is still a reliable procedure which can be used widel
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NewsBot · Sep 22, 2022

Primary Congenital Hallux Varus: A Step-Cut Surgical Approach
Panagiotis V Samelis et al
Cureus. 2022 Aug 16;14(8)

Hallux varus is a rare deformity of the forefoot, which is characterized by medial deviation of the proximal phalanx of the great toe at the metatarsophalangeal joint. It is usually acquired, secondary to failed hallux valgus surgery, trauma, neurologic or rheumatologic disease. Rarely, this deformity may be congenital, either isolated, or in the context of various underlying congenital malformations of the foot, such as poly-syndactyly or longitudinal epiphyseal bracket, or part of generalized skeletal malformations. We present a case of bilateral congenital hallux varus with concomitant short first metatarsal in a three-year-old girl. A step-cut soft-tissue surgical procedure to achieve proper alignment of the medial ray of the foot is described.
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NewsBot · Aug 7, 2023

Use of botulinum toxin as a non-surgical treatment option for idiopathic hallux varus: a case report
Caleb Gottlich, Alexandria Murphy, Neil Jain, Jerry Grimes
Journal of Surgical Case Reports, Volume 2023, Issue 7, July 2023, rjad423, https://doi.org/10.1093/jscr/rjad423

Hallux varus presents with midline deviation of the hallux at the first metatarsophalangeal joint. If left untreated, it may lead to pain and difficulty with normal daily activities. Here, we present a case of spontaneous hallux varus in an 84-year-old female treated non-operatively with injection of botulinum toxin in the Abductor Hallucis Brevis. Ultrasound guidance with electromyography was used to assist in all injections. Near total symptomatic relief and resumption of daily activities was obtained for up to 12 weeks at a time. Radiographic correction seen was improvement from 14° to 7° on weight bearing radiographs. After five rounds of treatment, no adverse reactions had been observed.
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NewsBot · Oct 25, 2024

Congenital Hallux Varus: A Rare Prenatal Detection and Postnatal Management
Prajakta Aloorkar , Gayathri Vemavarapu , Venkatram T. , Shantisree R.
Journal of Fetal Medicine 2024; 11(01): 076-080

Congenital hallux varus (CHV) is an uncommon anomaly of the forefoot where the big toe is positioned medially at the metatarsophalangeal joint, accompanied by a significant gap between the first and second toes. CHV is associated with difficulty in wearing clothes and footwear. CHV can cause pain that hampers the quality of life and can often be aesthetically displeasing.

Although prenatal presentation is rare, CHV can be detected by antenatal ultrasound with appropriate foot examination and a high index of suspicion. Early detection and management are recommended for optimizing antenatal and postnatal management as they may reduce the chance of permanent deformity.

We are herewith reporting a prenatally detected case of a CHV with polysyndactyly and its management. This is one of the few prenatally reported cases of isolated unilateral foot abnormalities.
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NewsBot · Nov 11, 2024

Rigid iatrogenic hallux varus: a decades’ worth experience with arthrodesis of the metatarsophalangeal joint
S. Belfiore, S. Vaggi, F. Vitali, A. Zanirato, E. Quarto & M. Formica
International Orthopaedics : 19 September 2024

Purpose
Arthrodesis of the first ray metatarsophalangeal joint (MPJ) is the gold standard in iatrogenic hallux varus (IHV) in the presence of stiffness and osteoarthritis. The purpose of this study is to collect clinical and radiographic results and complications of MPJ arthrodesis in rigid iatrogenic HV.

Methods
A retrospective evaluation of rigid iatrogenic HV undergoing arthrodesis with a minimum follow-up (FU) of two years was performed. The clinical parameters assessed were visual analog scale (VAS), the AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score and the satisfaction scale. The radiological parameters evaluated the first to second metatarsal angle (IMA) and the angle of hallux valgus (HVA). Complications were also analysed.

Result
A total of 18 patients (19 procedures) with a mean FU of 5.5 ± 2.5 years were included. The mean VAS improved from 7.3 ± 1.6 to 1.3 ± 1.2 (p < 0.05) at the last FU. Similarly, the AOFAS Hallux Metatarsophalangeal-Interphalangeal scale score significantly improved to 82 ± 9.2 (p < 0.05). Radiological evaluation demonstrated a 1–2 IMA improvement from 4.4 ± 2.2° preoperatively to 8.9 ± 2.4° at 3 months post-operatively. Similarly, there was a significant (p < 0.05) improvement of the HVA from − 22.7 ± 4.1° to 13.1 ± 4.1° at three months post-operative (p < 0.05). No signification loss of correction was noted at the last follow-up (p > 0.05). In one case, a delayed fusion at the arthrodesis site required surgical revision to promote fusion. No patient experienced pain with stress from the first MTP joint arthrodesis site or identified the arthrodesis site as a source of pain. No patient required implant removal. Re-operation and revision rates were 5.3%. The overall complications rate was 15.8%.

Conclusions
MPJ fusion effectively corrects Iatrogenic Hallux Varus in cases of rigid and fixed deformities in the medium- to long-term follow-up, with lasting improvements in AOFAS and VAS scores. The procedure is characterised by a non-negligible risk of complications, reoperations and revisions.
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NewsBot · Feb 16, 2025

Iatrogenic Hallux Varus in a Patient with Rheumatoid Arthritis
Mercedes Ortiz-Romero et al
Healthcare (Basel). 2025 Jan 21;13(3):217.

Background/Objectives: Iatrogenic hallux varus is a rare complication often arising after hallux valgus surgery, characterized by medial deviation of the hallux. This report presents the case of a 58-year-old female with iatrogenic hallux varus complicated by rheumatoid arthritis (RA). The objective is to highlight the challenges and outcomes of surgical treatment in RA patients with complex foot deformities. Methods: The patient presented with severe medial deviation of the hallux and claw positioning of the lesser toes, resulting in pain and functional limitations. Radiological analysis indicated overcorrection of the first intermetatarsal angle and deformity of the lesser toes. Surgical management included arthrodesis of the first metatarsophalangeal (MTP) joint using K-wires and resection arthroplasty of the lesser metatarsals. Results: Postoperative outcomes revealed correct alignment, pain reduction, and restoration of functional capabilities. However, a non-union was observed in the first MTP arthrodesis after 24 months, which remained asymptomatic. Conclusions: This case underscores the importance of careful surgical planning in RA patients to balance joint preservation and deformity correction. Arthrodesis proved effective for stability and pain relief in RA-associated deformities, although long-term follow-up remains critical to address complications. Tailored interventions are necessary to improve the quality of life in RA patients with complex foot deformities.
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NewsBot · Jun 13, 2025

An Avant-Garde, minimally traumatic surgical technique for hallux varus with lesser digit deviation; a comprehensive review
Zachary A. Shih et al
Journal of Orthopaedic Reports 10 June 2025, 100705

Non-iatrogenic hallux varus, a rare deformity without prior surgical history, presents unique challenges when compounded by medial deviation of lesser digits. This case report details a 57-year-old female with non-iatrogenic hallux varus managed via a novel hybrid technique combining lateral collateral ligament (LCL) stabilization with suture anchors, and medial capsule release. Concurrent second metatarsophalangeal joint (MPJ) stabilization using the "keystone concept" indirectly realigned lesser digits without direct osteotomies. Postoperative hallux valgus angle improved, with restored lesser digit alignment and preserved hallux dorsiflexion. Functional, Rapid recovery underscores this approach as a less invasive alternative to traditional arthrodesis or multi-metatarsal osteotomies.
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Surgery for hallux varus

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Hallux Valgus Surgery is Failing Long Term

Epidemiology of hallux valgus surgery

Chronic pain syndrome following hallux valgus surgery

Do Patients Aged 70 Years and Older Benefit From Hallux Valgus Surgery?

First metatarsal length in hallux valgus surgery

Overcoming barriers in hallux valgus surgery

Weightbearing after hallux valgus surgery

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Surgery for hallux varus

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Hallux Valgus Surgery is Failing Long Term

Epidemiology of hallux valgus surgery

Chronic pain syndrome following hallux valgus surgery

Do Patients Aged 70 Years and Older Benefit From Hallux Valgus Surgery?

First metatarsal length in hallux valgus surgery

Overcoming barriers in hallux valgus surgery

Weightbearing after hallux valgus surgery

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