A systematic review of biomechanical studies utilising finite element analysis in hallux valgus deformity

Hallux valgus (HV) is a common foot deformity affecting around 19 % of adults. Finite element analysis (FEA) is a valuable computational tool for investigating the complex biomechanics of foot deformities. This systematic review evaluates FEA studies investigating HV biomechanics, surgical correction techniques and fixation methods.

Medline, EMBASE, PubMed, and Cochrane Library databases were searched from inception to 2025. Included studies employed FEA to investigate HV biomechanics, with or without surgical intervention. An adaption of the ROBFEAD tool was used to assess bias.

19 studies met inclusion criteria (12 surgical, 7 biomechanical). All studies demonstrated moderate to high risk of bias. Biomechanical analyses revealed increased lateral metatarsal loading (40-55 % higher stress) and medial shift of peak pressures at the MTPJ. Surgical technique analyses demonstrated metatarsal shortening up to 6 mm could be accommodated before significantly altering foot loading patterns. Fixation studies showed superiority of dual fixation methods in minimally invasive surgery.

FEA provides valuable insights into HV biomechanics and surgical optimization. The data supports dual fixation approaches, precise osteotomy parameters, and caution regarding post-operative protocols.