Rotational deformity in hallux valgus is a recognized component and a demonstrated recurrence factor in patients who have undergone surgery. More than 20 years ago, publications started reporting metatarsal pronation as part of the hallux valgus pathology. Identifying metatarsal pronation should be part of the preoperative angular measurements. The proximal metatarsal rotational osteotomy and Lapidus fusion are some of the few techniques that reliably correct metatarsal pronation. They have good results, with more nonunions reported for the Lapidus. The authors present their hallux valgus treatment algorithm that includes metatarsus varus severity, tarsometatarsal instability, and rotational deformity among its variables.
Keywords: Algorithm; Hallux valgus; Metatarsal pronation; Rotational deformity; Treatment; proximal metatarsal rotational osteotomy.
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