Incidence of deformity recurrence after surgical treatment of hallux valgus toe - risk factors and prevention
DOI:
https://doi.org/10.12775/QS.2025.45.66502Keywords
hallux valgus, Recurrence, surgical treatment, postoperative careAbstract
Introduction: Hallux valgus (HV) is a prevalent forefoot deformity, defined by lateral deviation of the great toe and medial displacement of the first metatarsal. When conservative measures fail, surgical correction is often required. Despite numerous refined techniques, postoperative recurrence remains a significant clinical challenge, with rates varying depending on the procedure and patient-specific factors.
Aim: This review systematically evaluates the incidence of HV recurrence after surgery, identifies anatomical, radiographic, and procedural risk factors, and assesses strategies to prevent relapse and optimize long-term outcomes.
Methods: A comprehensive literature review was conducted using PubMed, Google Scholar, Scopus, and ResearchGate.
Results and Conclusion: HV recurrence is influenced by multiple factors, particularly pre- and postoperative radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid position. Effective prevention relies on individualized surgical planning, precise correction of deformities, and structured postoperative management, including physiotherapy and appropriate footwear. Recognizing modifiable risk factors and applying evidence-based strategies can reduce recurrence rates and improve patient satisfaction, highlighting the importance of tailored long-term care in HV management.
References
1.Ezzatvar Y, López-Bueno L, Fuentes-Aparicio L, Dueñas L. Prevalence and predisposing factors for recurrence after hallux valgus surgery: a systematic review and meta-analysis. J Clin Med. 2021 Dec 9;10(24):5753. doi: 10.3390/jcm10245753.
2.Barg A, Harmer JR, Presson AP, Zhang C, Lackey M, Saltzman CL. Unfavorable outcomes following surgical treatment of hallux valgus deformity: a systematic literature review. J Bone Joint Surg Am. 2018 Sep 19;100(18):1563-1573. doi: 10.2106/JBJS.17.00975.
3.Weigelt L, Davolio N, Torrez C, Haug F, Kühne N, Wirth SH. Long-term results after hallux valgus correction with distal metatarsal reversed-L (ReveL) osteotomy: factors that influence recurrence and the clinical outcome. JB JS Open Access. 2024 Sep 13;9(3):e24.00042. doi: 10.2106/JBJS.OA.24.00042.
4.Choi GW, Choi WJ, Yoon HS, Lee JW. Additional surgical factors affecting the recurrence of hallux valgus after Ludloff osteotomy. Bone Joint J. 2013 Jun;95-B(6):803-8. doi: 10.1302/0301-620X.95B6.31172.
5.Bock P, Kluger R, Kristen KH, Mittlböck M, Schuh R, Trnka HJ. The Scarf osteotomy with minimally invasive lateral release for treatment of hallux valgus deformity: intermediate and long-term results. J Bone Joint Surg Am. 2015 Aug 5;97(15):1238-45. doi: 10.2106/JBJS.N.00971.
6.Castioni D, Fanelli D, Gasparini G, Iannò B, Galasso O. Scarf osteotomy for the treatment of moderate to severe hallux valgus: analysis of predictors for midterm outcomes and recurrence. Foot Ankle Surg. 2020 Jun;26(4):439-44. doi: 10.1016/j.fas.2019.05.013.
7.Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2007 Oct;89(10):2163-72. doi: 10.2106/JBJS.F.01455.
8.Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009 Jul;91(7):1637-45. doi: 10.2106/JBJS.H.00796.
9.Okuda R, Kinoshita M, Yasuda T, Jotoku T, Shima H, Takamura M. Hallux valgus angle as a predictor of recurrence following proximal metatarsal osteotomy. J Orthop Sci. 2011 Nov;16(6):760-4. doi: 10.1007/s00776-011-0136-1.
10.Weigelt L, Davolio N, Torrez C, Haug F, Kühne N, Wirth SH. Long-term results after hallux valgus correction with distal metatarsal reversed-L (ReveL) osteotomy: factors that influence recurrence and the clinical outcome. JBJS Open Access. 2024 Sep 13;9(3):e24.00042. doi: 10.2106/JBJS.OA.24.00042.
11.Clarke TAC, Platt SR. Treatment of hallux valgus by Scarf osteotomy - rates and reasons for recurrence and rates of avascular necrosis: a systematic review. Foot Ankle Surg. 2021 Aug;27(6):622-8. doi: 10.1016/j.fas.2020.08.009.
12.Pentikainen I, Ojala R, Ohtonen P, Piippo J, Leppilahti J. Preoperative radiological factors correlated to long-term recurrence of hallux valgus following distal chevron osteotomy. Foot Ankle Int. 2014 Dec;35(12):1262-7. doi: 10.1177/1071100714548703.
13.Galli SH, Johnson N, Davis WH, Anderson RB, Jones CP, Cohen BE. Radiographic outcomes and recurrence following 126 primary Lapidus surgeries for hallux valgus. Foot Ankle Orthop. 2020 Jul 7;5(2):2473011420S00005. doi: 10.1177/2473011420S00005.
14.Galli SH, Johnson N, Davis WH, Anderson RB, Jones CP III, Cohen BE. Patient reported outcomes and recurrence following 127 primary Lapidus surgeries for hallux valgus. Foot Ankle Orthop. 2020 Nov 6;5(4):2473011420S00222. doi: 10.1177/2473011420S00222.
15.Espinosa N, Meyer DC, Von Campe A, Helmy N, Vienne P. A new modified distal first metatarsal osteotomy for the treatment of hallux valgus deformity: the reversed L-shaped osteotomy. Tech Foot Ankle Surg. 2006 Sep;5(3):190-7. doi: 10.1097/01.btf.0000221101.31792.8b.
16.Park CH, Lee WC. Recurrence of hallux valgus can be predicted from immediate postoperative non-weight-bearing radiographs. J Bone Joint Surg Am. 2017 Jul 19;99(14):1190-7. doi: 10.2106/JBJS.16.00980.
17.Suh JW, Kim SH, Park HW. Radiographic risk factors of recurrent hallux valgus deformity after modified Scarf and Akin osteotomy. J Korean Foot Ankle Soc. 2019;23(4):159-65.
18.Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009 Jul;91(7):1637-45. doi: 10.2106/JBJS.H.00796.
19.Su P-H, Lin C-W, Chiang C-H, Wang W-C, Yeh C-W, Chen H-T, Fong Y-C, Kuo C-C. Sesamoid bone reduction in hallux valgus: comparing radiological outcomes of hallux valgus following distal chevron osteotomy and modified McBride procedure. J Clin Med. 2024;13(24):7590. doi: 10.3390/jcm13247590.
20.Lau B, Allahabadi S, Palanca A, Oji D. Understanding radiographic measurements used in foot and ankle surgery. J Am Acad Orthop Surg. 2021;30(2):e139-54. doi: 10.5435/jaaos-d-20-00189.
21.Encinas R, Hall S, Edelman D, et al. Correction of distal metatarsal articular angle in hallux valgus surgery utilizing a minimally invasive extra-articular metaphyseal distal transverse osteotomy. Foot Ankle Spec. 2025;0(0). doi: 10.1177/19386400251317597.
22.Suh JW, Park SG, Kim SH, Park HW. Radiologic recurrence of hallux valgus deformity after Scarf and Akin osteotomy in patients with high distal metatarsal articular angle. Foot Ankle Orthop. 2019 Nov 4;4(4):2473011419S00415. doi: 10.1177/2473011419S00415.
23.Li X, Guo M, Zhu Y, Xu X. The excessive length of first ray as a risk factor for hallux valgus recurrence. PLoS One. 2018 Oct 10;13(10):e0205560. doi: 10.1371/journal.pone.0205560.
24.Wirth SH, Espinosa N, Stouggar M, et al. Planning tool for first metatarsal length in hallux valgus surgery. Foot. 2021;46:101774.
25.Milczarek MA, Milczarek JJ, Tomasik B, et al. Being overweight has limited effect on SCARF osteotomy outcome for hallux valgus correction. Int Orthop. 2017;41:765–72. doi: 10.1007/s00264-017-3419-0.
26.Carlucci S, Cafruni VM, Alberti M, Verbner JM, Santini-Araujo MG, Conti LA, Sotelano P, Carrasco NM. Is obesity a risk factor in percutaneous hallux valgus surgery? Foot Ankle Surg. 2021 Jul;27(5):577-80. doi: 10.1016/j.fas.2020.07.013.
27.Goh GS, Tay AYW, Thever Y, Koo K. Effect of age on clinical and radiological outcomes of hallux valgus surgery. Foot Ankle Int. 2021;42(6):798-804. doi: 10.1177/1071100720982975.
28.Beck D, Raikin S, Park A. Recurrent hallux valgus: 15 year single surgeon series. Foot Ankle Orthop. 2017;2(3). doi: 10.1177/2473011417S000116.
29.Kristen KH, Berger K, Berger C, Kampla W, Anzbock W, Weitzel SH. The first metatarsal bone under loading conditions: a finite element analysis. Foot Ankle Clin. 2005;10(1):1–14.
30.Polastri M. Postoperative rehabilitation after hallux valgus surgery: a literature review. Foot Ankle Online J. 2011;4(4).
31.Navarro-Cano E, Guevara-Noriega KA, Lucar-Lopez G, Reina F, Carrera A. A comparison of two designs of postoperative shoe for hallux valgus surgery: a biomechanical study in a cadaveric model. Foot Ankle Surg. 2021 Jan;27(1):82-6. doi: 10.1016/j.fas.2020.02.010.
32.Schuh R, Hofstaetter SG, Adams SB, Pichler F, Kristen KH, Trnka HJ. Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase. Phys Ther. 2009 Sep;89(9):934-45. doi: 10.2522/ptj.20080375.
33.Physiotherapy after hallux valgus surgery. MEDIS – Int J Med Sci Res. 2025;4(1):89–92. Available from: https://medisij.com/index.php/mij/article/view/16
34.Pawłowski B, Madej A, Haczkur-Pawłowska K, Kowal A, Jasiński K, Kuzio A, et al. Orthoses and other conservative methods in hallux valgus. Quality in Sport [Internet]. 2024 Sep 30 [cited 2025 May 28];23:54937. Available from: https://apcz.umk.pl/QS/article/view/54937
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Aleksandra Szeliga, Tomasz Karol Książek, Anna Ewelina Francuziak, Piotr Mikołaj Dembicki, Kinga Kozłowska, Maciej Borowski, Natalia Dzieszko, Michał Szczepański, Weronika Kalinowska, Paulina Sara Kulasza

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 145
Number of citations: 0