Introduction Epidemiology presents in children after walking age Pathophysiology deformity at metatarsophalangeal joint due to imbalance between the great toe abductor and adductors pathoanatomy firm, fibrous, band-like abductor hallucis muscle short, thick first metatarsal longitudinal bracket epiphysis of the 1st metatarsal underlying skeletal dysplasia (diastrophic dwarfism) do not confuse with metatarus primus varus varus deformity of the 1st metatarsal (no deformity at MTP joint) Risk factors longitudinal epiphyseal bracket of the first metatarsal or proximal phalanx Associated conditions often associated with polydactyly Presentation Symptoms cosmetic deformity difficult to put on shoes usually painless Deformity can vary in severity few degrees to 90 degress Imaging Radiographs recommended views of the foot AP lateral oblique findings short, thick 1st metatarsal Differential Must be differentiated from metatarsus adductus Treatment Nonoperative observation alone indication rare as deformity is thought to worsen with age surgical correction often proposed in infancy Operative abductor hallucis muscle release indication mild and resistant deformities excision of central portion of epiphyseal bracket indication if epiphyseal bracket found to be the cause of Hallux Varus resumption of longitudinal growth common if performed at a young age secondary corrective realignment or lengthening is sometimes needed Farmer technique indication moderate to severe deformities technique creates syndactyly between the 2nd toe and hallux maintains deformity correction Complications Recurrence of deformity Incomplete correction of deformity