Hallux valgus: Indications and technique of proximal chevron osteotomy combined with distal soft tissue release

Acquired hallux valgus deformity arises from progressively changing relationships of the bones in the first ray of the foot. Ligamentous laxity develops at the medial capsule of the first metatarsophalangeal (MTP) joint and the lateral capsule of the first metatarsocuneiform joint. The adductor hallucis tendons and the transverse metatarsal ligament tether the sesamoid bones and the base of the proximal phalanx of the great toe while the intermetatarsal angle (IMA) increases. These deforming forces are addressed by the distal soft tissue release in the first web space and the soft tissue plication at the medial aspect of the first MTP joint. The addition of the proximal chevron osteotomy of the first metatarsal shaft permits complete correction of the increased hallux valgus and intermetatarsal angles. The improved stability of the proximal chevron osteotomy over other types of osteotomies theoretically reduces the incidence of delayed transfer metatarsalgia. This article will show the anatomy of acquired hallux valgus, as well as the theories and techniques behind the authors' method of surgical correction.