A 30-year-old woman has symptomatic hallux valgus unrelieved by wide shoes. Weight-bearing radiographs show a hallux valgus angle of 22 degrees, an intermetatarsal angle of 11 degrees, a normal distal metatarsal articular angle, and lateral subluxation of the sesamoids. The most appropriate surgical combination is:
- A Akin phalangeal osteotomy alone
- B Distal soft tissue procedure with chevron (Austin) osteotomy ✓
- C Proximal first metatarsal osteotomy with distal soft tissue procedure
- D First MTP arthrodesis
Correct answer: B. Distal soft tissue procedure with chevron (Austin) osteotomy
Explanation
An IMA of 11 degrees defines mild to moderate deformity without significant metatarsus primus varus, for which a distal metatarsal osteotomy such as the chevron combined with a distal soft tissue release corrects both the bony and soft tissue components. Proximal osteotomies are reserved for IMA greater than about 13 degrees because they carry a higher risk of shortening and transfer metatarsalgia. An Akin osteotomy alone cannot correct an increased IMA.
Reference: Campbell's Operative Orthopaedics, 14th ed.
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