Management of Iatrogenic Hallux Varus with Local Soft Tissue Reconstruction: A Case Series with Mid-Term Outcomes

Iatrogenic hallux varus is a rare but functionally disabling complication most commonly following hallux valgus surgery. Traditional revision techniques, such as tendon transfer or arthrodesis, may compromise joint mobility or require implants. This study evaluates a biologically autologous alternative-local soft tissue myoligamentoplasty-for the correction of flexible deformities. # Methods A retrospective case series of seven patients (mean age 62 years) with flexible iatrogenic hallux varus following prior hallux valgus surgery was conducted at a single tertiary care center. All patients underwent local soft tissue myoligamentoplasty using an F-shaped medial capsular flap and lateral release via a double-incision approach. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) hallux score, and radiographic measurements (hallux valgus angle [HVA], intermetatarsal angle [IMA]) over a 12-month follow-up. # Results Mean VAS improved significantly from 6.1 ± 1.2 preoperatively to 1.4 ± 0.8 at 12 months (p < 0.01), and AOFAS scores increased from 47.6 ± 6.9 to 83.7 ± 7.1 (p < 0.01). HVA was corrected from -15.4° ± 4.3° to 2.7° ± 3.8° (p < 0.01), while IMA remained unchanged (10.3° ± 1.9° to 9.8° ± 2.1°, p = 0.12), indicating mechanical neutrality. No recurrences, reoperations, or complications were reported. Patient satisfaction was high, with 5/7 "completely satisfied" and 2/7 "satisfied with minor concerns." # Conclusion Local soft tissue myoligamentoplasty offers a safe, effective, and joint-preserving surgical option for correcting flexible iatrogenic hallux varus. The technique provides durable pain relief, functional improvement, and cosmetic restoration without the need for tendon harvesting or implants, making it especially suitable for patients with preserved joint surfaces or in resource-limited settings.