This protocol addresses patients with symptomatic hallux valgus and ongoing forefoot pain at the first metatarsophalangeal (MTP) joint whose deformity measures within the mild range — specifically a hallux valgus angle of 15–20° or a first intermetatarsal angle of 9–14°.
This protocol applies after a conservative programme for mild hallux valgus — including analgesia, footwear assessment and modification, offloading orthotics for the first MTP joint, physiotherapy for balance, proprioception, and core stability, and therapeutic injection of the first MTP joint where indicated — failed to achieve resolution of forefoot pain at the first MTP joint or meaningful improvement in foot function.
The protocol below describes the next clinical step taken when those goals remain unmet.
Symptomatic patients typically present with a gradual onset of sharp pain at the MTP joint that is worse on weight bearing. The hallux valgus angle and intermetatarsal angle are used to classify deformity severity and guide management decisions.
Surgical correction involves a specific osteotomy technique at the distal first metatarsal designed to reduce the intermetatarsal angle and restore alignment of the hallux. The procedure may be carried out through open or minimally invasive means — the complete selection criteria, technical pathway, and post-operative management are set out in the full protocol.
Treatment goals include resolution of forefoot pain at the first MTP joint, restoration of proper hallux alignment, and return of the hallux valgus angle and intermetatarsal angle to within normal ranges (HVA 0–15°, IMA 0–9°).
DOI: 10.7759/cureus.96642
Symptomatic patients typically present with a gradual onset of sharp pain at the metatarsal phalangeal (MTP) joint that is worse on weight bearing.
NICE uses the HVA and intermetatarsal angle (IMA) to sub-classify the severity of the deformity. Patients must meet at least one of the criteria in the rows to be diagnosed.
For mild HV, a distal first metatarsal (MT) osteotomy (cutting and reorienting of bone) may be performed, most commonly through the chevron technique.
This technique involves the lateral displacement of the metatarsal head to reduce the IMA. A medial incision is made over the first metatarsophalangeal joint (MTPJ). The bursa is excised, and a V-shaped osteotomy is performed, allowing the metatarsal head to be shifted laterally toward the second toe to restore alignment and reduce the IMA.
They concluded that minimally invasive and open procedures have a similar efficacy and risk profile, with comparable patient-reported outcomes and recovery times for all severities of deformity.
Surgical correction of HV aims to alleviate pain and improve foot function through restoration of the proper alignment of the hallux.