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 widely.
Keywords: Metatarsophalangeal fusion; Post-operative hallux varus; Reverse scarf osteotomy.
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