Hallux valgus is the consequence of a partial dislocation of the metatarsophalangeal joint of the 1st ray. The internal (medial) capsule tears, the 1st metatarsal moves away from the 2nd and the toe turns towards the 2nd toe. A sagging forefoot is still present and there is often a "claw" retraction of the 2nd toe.

Various causes are cited as predisposing factors to this deformity: family predisposition, high-heeled shoes, shoes that are too narrow, short 1st metatarsal, being overweight, etc. Functional Hallux Limitus is however the main factor of the deformation and it is systematically found in hallux valgus. On clinical examination, the FHL stretch test is positive in 98% of cases despite the deviation of the toe.

Considering this factor to be predisposing, we always associate a flexor hallucis longus tendon pulley release procedure with surgical corrections of the hallux valgus.

When the deformity is proven and symptomatic, we offer surgical treatment in the form of a bone realignment of the 1st metatarsal associated with the recentering of the sesamoid strap by release of the external structures and reconstitution of the capsule on the medial side of the 1st metatarsophalangeal joint. A correction of the basal phalanx of the big toe is sometimes added to the bone correction of the 1st metatarsal. Correction of the deformity of the other toes is performed at the same surgical time if necessary. Endoscopic tenolysis of the flexor hallucis longus is routinely offered in order to prevent joint stiffness in the 1st metatarsophalangeal joint and to limit the risk of recurrence of the deformity.