Surgical management and postoperative imaging assessment of hallux valgus

Abstract

Abstract Hallux valgus (HV) is a common and complex three-dimensional deformity of the first ray, resulting from multifactorial interactions involving anatomical, biomechanical, ligamentous, muscular, and extrinsic factors. The absence of a single etiological mechanism explains the wide variety of proposed surgical techniques and highlights the need for individualized management. The therapeutic strategy is based on a structured radioclinical weight-bearing assessment integrating angular parameters, first-ray stability, sesamoid alignment, and joint status. Depending on the severity of the deformity and the presence of associated instability, surgical options include distal, diaphyseal, or proximal osteotomies, Lapidus tarsometatarsal arthrodesis, and metatarsophalangeal arthrodesis. Certain complex situations, particularly those associated with metatarsus adductus or juvenile HV, require specific morphological analysis because of an increased risk of recurrence and particular biomechanical constraints. Postoperative imaging plays a central role in the assessment of surgical outcomes. It allows evaluation of deformity correction, osteotomy healing, fixation stability, sesamoid repositioning, and restoration of first-ray alignment. Weight-bearing radiographs remain the reference examination, whereas WBCT enables a more precise three-dimensional analysis of rotational correction, first metatarsal pronation, and the sesamoid complex. Imaging is also essential for the detection of postoperative complications, including recurrence, malunion, nonunion, avascular necrosis, transfer metatarsalgia, infection, osteoarthritis, and nerve injury. WBCT currently represents a major complementary tool for the analysis of multiplanar corrections and their biomechanical consequences. Thorough knowledge of normal and pathological postoperative findings is essential to optimize the management of HV.