Predictors and Prevention of Hallux Valgus Recurrence After Primary Surgical Correction: A Structured Narrative Review.

Abstract

Hallux valgus recurrence remains one of the most important causes of unsatisfactory outcomes following corrective surgery, with reported rates varying widely because of differences in patient selection, surgical techniques, follow-up duration, and recurrence definitions. Although numerous operative procedures have been described, growing evidence indicates that durable correction depends less on the specific procedure performed than on appropriate patient selection and complete correction of the underlying deformity. A structured literature search was conducted in PubMed from database inception to 4 August 2026 and supplemented by reference-list screening. Adult primary surgical studies reporting recurrence or factors associated with recurrence were eligible when they provided an explicit recurrence definition and at least 12 months of follow-up. Forty candidate primary studies were assessed in full text, of which 30 were included in the core evidence synthesis. Findings were synthesized narratively within predefined domains covering recurrence definitions, preoperative factors, procedure selection, technical correction, postoperative alignment, patient-related factors, and clinical consequences. Particular attention is given to the role of three-dimensional deformity correction, soft-tissue balancing, sesamoid realignment, and radiographic parameters including the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and metatarsal rotation. Contemporary surgical techniques, including Chevron, Scarf, Lapidus, first metatarsophalangeal joint fusion, and minimally invasive procedures, are reviewed with respect to their indications, recurrence mechanisms, and technical considerations. Based on the available evidence, recurrence prevention requires a comprehensive strategy integrating accurate preoperative assessment, procedure selection tailored to the underlying pathology, meticulous surgical technique, and structured postoperative follow-up. Standardized recurrence definitions and greater use of weight-bearing three-dimensional imaging may further improve future research and clinical decision making.