In hallux valgus deformity, the intermetatarsal angle (IMA) is 16° and the hallux valgus angle (HVA) is 35°. No degenerative change is present. The most appropriate surgical correction is:

• A Distal chevron (Austin) osteotomy of the first metatarsal
• B Keller's arthroplasty (proximal phalangeal base resection)
• C Lapidus procedure (first tarsometatarsal arthrodesis) for moderate deformity without hypermobility
• D Proximal opening-wedge or closing-wedge first metatarsal osteotomy (e.g., Ludloff, Scarf, or proximal crescentic osteotomy) ✓

Explanation

Mild-to-moderate hallux valgus (HVA < 30°, IMA < 13°) is treated by distal metatarsal osteotomy (chevron). Moderate-to-severe deformity with IMA > 13–15° and HVA > 30–40° requires proximal or diaphyseal correction — Scarf, Ludloff, or proximal crescentic osteotomy — which can correct larger IMAs. Keller's arthroplasty is reserved for elderly low-demand patients with arthritis. Lapidus is specifically indicated with first TMT hypermobility.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.