Hallux valgus is a common forefoot pathology often requiring surgical intervention for symptomatic relief. One complication of
hallux valgus correction is flexible
hallux varus. Iatrogenic flexible
hallux varus often requires surgical repair; however, the most advantageous
surgical procedure for repair of iatrogenic flexible
hallux varus and their sustainability remains unclear. Therefore, we performed a systematic review to determine the sustainability of soft-tissue release with
tendon transfer for the correction of iatrogenic flexible
hallux varus. Studies were eligible for inclusion only if they involved failure of soft-tissue release with
tendon transfer for flexible iatrogenic
hallux varus. Eight studies met our inclusion criteria, seven of which were evidence-based medicine level IV studies and one was level V. A total of 52 patients, all female, involving 68 feet, were included. All studies included soft-tissue release of the first metatarsal-phalangeal joint capsule and 1 of the following procedures: Johnson transfer of the extensor hallucis longus tendon with
arthrodesis of the hallux interphalangeal joint (41 feet); Hawkins transfer of the abductor hallucis tendon (9 feet); reverse Hawkins transfer (7 feet); Valtin transfer of the first dorsal interosseous tendon (7 feet); and Myerson transfer of the extensor hallucis brevis tendon (4 feet). The weighted mean age of the patients was 50.4 years, and the weighted mean follow-up was 30.2 months. A total of 11 complications (16.2%) occurred. Of note, only 3 cases (4.4%) of recurrent
hallux varus deformity developed, all of which occurred after Johnson transfer of the extensor hallucis longus tendon, with
arthrodesis of the hallux interphalangeal joint. Our results support that sustainable correction of iatrogenic flexible
hallux varus can be achieved with soft-tissue release of the first metatarsal-phalangeal joint combined with a variety of
tendon transfer procedures. However, given the limited data available, potential areas for additional prospective investigation remain.