J. A. MILLS, M. B. MENELAUS From the Royal Children’s Hospital, Melbourne
We reviewed 12 patients with congenital hallux varus who had had operations on 20 feet to enable them to wear normal shoes and to improve the appearance. After an average follow-up of 12.7 years the results of soft tissue procedures were satisfactory in 12 of 17 feet. Arthrodesis of the first metatarsophalangeal joint, performed primarily in one foot and secondarily in two others was also satisfactory, but metatarsal osteotomy in two feet gave unsatisfactory results leading to local amputation. The unsatisfactory results were generally due to the appearance of shortness of the first metatarsal and rarely because of symptoms or recurrent deformity.

ACFAS Clinical Practice Guidelines on hallux varus

Am J Hum Genet. 1972 November; 24(6 Pt 1): 694–701. Joe C. Christian, Kyu S. Cho, Edmund A. Franken, and Barry H. Thompson

eMedicine article Amy Ptaszek 2004

ALLAN M. BOIKE GLORIA CHRISTIN Hallux varus resulting from both iatrogenic and idio- pathic causes has been reported throughout the po- diatric and orthopedic literature. Although hallux varus acquired as a complication of bunion surgery occurs much more frequently, those unique cases of congenital deformity may occasionally present to a practitioner's office.
from Textbook of Hallux Valgus & Forefoot Surgery

Clinical signs
Autosomal recessive inheritance
Metatarsus adductus
Wide space between 1st-2nd toes
Broad/bifid great toe
Clinodactyly of fifth finger
Preaxial polydactyly of toes
Syndactyly of toes

Source: Clinical Practice Guideline First Metatarsophalangeal Joint Disorders Panel. Diagnosis and treatment of first metatarsophalangeal joint disorders. J Foot Ankle Surg 2003 May-Jun;42(3):112-54.

Hallux varus is most commonly due to over-correction of hallux valgus. The following technical errors predispose to over-correction:
* over-release of the lateral capsule of the 1st MTP joint
* over-resection of the medial eminence of the 1st MT head
* fibular sesamoidectomy (especially in the traditional McBride procedure)
Hallux varus may also be congenital, often in association with metatarsus varus, and occasionally occurs as a neuromuscular deformity.
Up to 15° of hallux varus is usually well tolerated provided the toe is not too stiff.

Powerpoint Presentation on the anatomy and management of Hallux Abducto Valgus and Hallux Varus. C.S.Helu DPM Podiatry Resident NYCH

Diagnostic Dilemmas: How To Manage Postoperative Hallux Varus - By Justin Franson, DPM, and Babak Baravarian, DPM
Chances are, you have seen patients present to your office with pain after undergoing a bunion surgery, which you may or may not have performed. If you were the operating surgeon, it is easy enough to research the specific procedure that you performed. However, in many cases of hallux varus complications, the patients wind up in another surgeon’s office for reconstruction. Obtaining all the prior operative and post-op information will aid in tailoring the revisional surgery.

US Govt and Academic resources on Hallux Varus