First ray dysmorphia in hallux valgus: new insights and impact on surgical management.

Hallux valgus surgical correction faces a high rate of recurrence. Over the past few decades, surgeons' response to these disappointing results has been surgical technique multiplication, with no improvement in long-term outcomes. Over the same period, very little improvement has been made in our understanding of hallux valgus pathogenesis. First ray dysmorphia, which results in soft tissue imbalance around the first metatarsophalangeal joint, is suspected to be one such pathophysiological factor. Controlled studies have shown increased pronation of the first ray combined with valgus deviation of first metatarsal distal articular surface. Correction of these bony deformities may improve the outcome of hallux valgus surgery and is currently being assessed in a randomized control trial.