The Role of Distal Medial Cuneiform Angle in Hallux Valgus: A Systematic Review

The obliquity of the first metatarsocuneiform joint has long been proposed as a contributing factor in the development of hallux valgus (HV). Several studies have evaluated the medial slope of the distal articular surface of the medial cuneiform relative to its longitudinal axis, commonly described as the distal medial cuneiform angle (DMCA). An increased DMCA has been hypothesized to predispose individuals to HV by altering first-ray biomechanics. The objective of this study is to conduct a systematic review of the literature to determine whether DMCA is a significant risk factor for the development of HV. A systematic literature search was conducted across Ovid, Embase, MEDLINE, and PubMed databases on February 8, 2025, identifying studies published between January 2004 and December 2024. Searches used predefined MeSH terms, including obliquity, angulation, and medial cuneiform, followed by combined-term analysis. English-language full-text articles were screened, and reference lists were reviewed for additional studies. Eligible studies compared DMCA measurements between HV and control cohorts. Where appropriate, pooled effect sizes were calculated using Hedges' g. The review identified a limited number of heterogeneous observational studies evaluating DMCA in HV populations. Meta-analytic synthesis demonstrated a small but statistically significant association between increased DMCA and HV (Hedges' g = 0.19, p = 0.01). However, substantial variability was noted in measurement techniques, radiographic positioning, and definitions of HV severity, limiting comparability across studies. Current evidence demonstrates a statistically significant but small association between increased DMCA and HV. The modest effect size suggests that DMCA alone is unlikely to be a dominant causal factor and should be considered within a multifactorial biomechanical framework. Further high-quality, standardized studies are required to clarify the clinical relevance of DMCA in the pathogenesis of HV.