Hallux valgus is the progressive deformity of the foot, where the 1st metatarsal deviates inwards creating the characteristic bulging-exostosis (knuckle) and the big toe deviates outwards in relation to the rest of the toes.

The use of narrow shoes, heredity, flat feet and hyperpronation of the foot play an important role in its occurrence, while in a significant percentage of cases there is no predisposing factor.

Hallux valgus is a complex deformity and can directly affect the function of the entire forefoot and indirectly of the lower limb. The most common symptoms are pain on walking and standing, metatarsalgia, causalgia-burning pain, painful calluses, symptoms from the other toes and difficulty in finding appropriate and accomodating shoes.

Conservative treatment does not correct or stop the progression of the deformity but aims to improve the symptoms. It includes appropriate footwear with a roomy toe box, orthotics (insoles), silicone inserts between the toes and  painkillers.

Surgical treatment is recommended when symptoms and deformity worsen and should not be done for aesthetic reasons only. The operation aims to correct the deformities of the big toe as well as the other toes with the ultimate goal of restoring the architecture of the foot and full functionality without pain. Dozens of techniques have been used in the past, which highlights the difficulty of treating all cases satisfactorily with a single type of operation. More recently, reduced and minimally invasive techniques – percutaneous – have evolved. Minimally invasive techniques certainly offer a better aesthetic result but should only be used in specific cases as their incorrect use leads to severe complications.

   Careful peoperative planning is mandatory and is individualized depending on the severity of the deformities and other concomitant conditions such as arthritis, flat feet or joint hypermobility. It is performed under spinal or general anaesthesia and the length of hospitalisation is one day. Removal of the exostosis (knuckle), appropriate osteotomy and osteosynthesis of the first metatarsal, soft tissue balancing and corrective interventions on the other fingers if deformities are also present. The patient is able to walk without pain after the operation using a special postoperative shoe but it is recommended to avoid vigorous activity in order to have a short and uneventful postoperative recovery.