A 52-year-old woman has symptomatic hallux valgus with an intermetatarsal angle (IMA) of 18° and hallux valgus angle (HVA) of 38°. Conservative treatment has failed. Based on the degree of deformity, the most appropriate surgical procedure is:

• A Chevron (Austin) osteotomy of the first metatarsal head
• B Keller's resection arthroplasty of the proximal phalanx
• C Scarf osteotomy or proximal (Ludloff/crescentic) first metatarsal osteotomy ✓
• D McBride bunionectomy (medial exostectomy with lateral soft tissue release only)

Explanation

Hallux valgus severity guides procedure selection: mild (HVA<20°, IMA<13°) → distal osteotomy (chevron/Austin); moderate (HVA 20-40°, IMA 13-18°) → shaft osteotomy (scarf, Ludloff); severe (HVA>40°, IMA>18°) → proximal osteotomy (Lapidus/1st TMT fusion, proximal crescentic). This patient has IMA 18° and HVA 38° — borderline moderate-severe, best addressed by a scarf osteotomy (which can correct IMA up to 19-20°) or a proximal osteotomy. Chevron corrects only mild deformity (IMA<13°). Keller's is reserved for elderly low-demand patients. McBride alone is insufficient for structural deformity.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.