A 52-year-old woman presents with pain at the medial first metatarsophalangeal joint and forefoot crowding. Radiograph shows a hallux valgus angle (HVA) of 42° and an intermetatarsal angle (IMA) of 18°. The most appropriate surgical correction is:

• A Distal chevron (Austin) osteotomy
• B Scarf osteotomy or proximal crescentic osteotomy with metatarsophalangeal soft tissue correction ✓
• C Mitchell's osteotomy
• D Keller's arthroplasty (excision of proximal phalanx base)

Explanation

Hallux valgus severity guides surgical choice. Mild deformity (HVA <25°, IMA <13°): distal osteotomy (chevron/Austin). Moderate deformity (HVA 25–40°, IMA 13–16°): shaft-level osteotomy (scarf, Ludloff). Severe deformity (HVA >40°, IMA >18°) as in this patient requires proximal osteotomy (crescentic or Lapidus — first tarsometatarsal fusion) combined with distal soft tissue reconstruction. Keller's arthroplasty is reserved for elderly low-demand patients as it sacrifices the windlass mechanism and causes transfer metatarsalgia.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.