A patient with hallux valgus has an intermetatarsal angle of 16° and a hallux valgus angle of 32°. The distal metatarsal articular angle (DMAA) is normal. The most appropriate surgical procedure is:
- A Chevron (distal) osteotomy
- B Scarf osteotomy
- C Proximal osteotomy (crescentic or opening wedge) ✓
- D Keller's arthroplasty
Correct answer: C. Proximal osteotomy (crescentic or opening wedge)
Explanation
Surgical selection for hallux valgus is based on intermetatarsal angle (IMA). Chevron osteotomy corrects IMA <13° (mild-moderate deformity). Scarf osteotomy is used for IMA 12–18° (moderate deformity). When IMA exceeds 15–16°, a proximal first metatarsal osteotomy (crescentic, opening wedge, or Lapidus fusion) is required to achieve adequate correction. With IMA of 16°, a proximal osteotomy providing greater translational correction is preferred over distal osteotomy. Keller's is a salvage procedure for elderly patients with arthritis.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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