A 55-year-old woman with hallux valgus has a hallux valgus angle (HVA) of 38° and an intermetatarsal angle (IMA) between the first and second metatarsals of 18°. The most appropriate surgical procedure is:

• A Chevron (Austin) osteotomy of the first metatarsal head — a distal osteotomy
• B Scarf or Ludloff osteotomy — mid-shaft first metatarsal correction
• C Lapidus procedure (first tarsometatarsal arthrodesis) — proximal correction for severe deformity with hypermobility ✓
• D Simple bunionectomy (exostectomy) without osteotomy

Explanation

The severity of hallux valgus guides surgical selection. A Chevron osteotomy corrects IMA up to ~13° and HVA up to ~30° (mild-moderate deformity). For severe deformity (HVA >35–40°, IMA >15–16°), especially with first tarsometatarsal (TMT) hypermobility, the Lapidus procedure — arthrodesis of the first TMT joint — provides the most proximal and powerful correction, eliminating the hypermobile segment and correcting both angles. Simple exostectomy alone (without osteotomy) is contraindicated as it leads to recurrence. Scarf/Ludloff addresses moderate-severe deformity but has correction limits inferior to Lapidus for IMA >16°.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.