summary Hallux Varus is a condition characterized by the medial deviation of the hallux relative to the 1st metatarsal bone, most often the result of overcorrection from prior bunion surgery. Diagnosis is made clinically with varus angulation of the great toe. Treatment may be observation or operative depending on severity of varus, prior surgeries to the hallux, and patient symptoms. Epidemiology Incidence varies between 2-14% after corrective surgery for hallux valgus deformities Demographics more commonly seen in women Etiology Pathophysiology causes congenital login to view 1 more bullet acquired login to view 4 more bullets pathoanatomy loss of osseous support excessive resection of the medial eminence excision of fibular (lateral) sesamoid overrelease of lateral capsular structures overplication of medial capsule overtranslation of intermetatarsal angle or hallux valgus interphalangeus Orthopaedic manifestations hallux varus usually presents with three possible components medial deviation of the hallux relative to first MTP joint supination of the phalanx claw toe deformity Presentation History main complaint appearance of the great toe as being "too straight" to excessive medial deviation difficulty wearing shoes Symptoms often asymptomatic pain indicates underlying joint arthritis or trauma may also complain of decreased ROM, instability, weakness with push-off Physical exam inspection varus anglulation of great toe dorsal contracture of the MTP joint with or without IP joint contracture EHL may be medially displaced, creating a "bowstring" deformity tibial (medial) sesamoid may be medially displaced motion determine if fixed or flexible deformity Imaging Radiographs recommended views weight-bearing AP & lateral views of the foot, additional views non-weightbearing oblique views, and sesamoid axial views findings hallux valgus angle < 0 degrees (normal 5-15 degrees) excessive medial eminence resection overcorrection osteotomies reduced IMA between first and second metatarsals medial subluxation of tibial seasmoid absent lateral seasmoid degenerative changes at MTP or IP joint CT scan or MRI indications not usually required may be considered if underlying osteonecrosis of first metatarsal Treatment Nonoperative shoe modifications to accommodate the deformity indications login to view 2 more bullets modalities login to view 2 more bullets outcomes login to view 1 more bullet taping or splinting the deformity indications login to view 1 more bullet modalities login to view 2 more bullets outcomes login to view 1 more bullet Operative lateral closing wedge osteotomy indications login to view 1 more bullet techniques login to view 2 more bullets tendon transfer with medial release indications login to view 1 more bullet techniques login to view 6 more bullets first MTP arthrodesis indications login to view 5 more bullets Prognosis Natural history of disease in established hallux varus, the role of nonoperative management is limited