The authors present the case of a 54-year-old female who developed a painful
compression lesion localized to the medial aspect of the base of the distal
phalanx of the great toe as a complication of hallux valgus surgery. Preoperative
radiographic evaluation of the patient's foot revealed the first ray to be longer
than the second, a 12 degrees first intermetatarsal angle, a 33 degrees hallux
abductus angle, and an exostosis at the medial aspect of the base of the hallux
that was not considered by the surgeon to be important. Correction of the hallux
valgus deformity was performed with a combination of scarf and Akin osteotomies,
and the intermetatarsal and hallux abductus angles reduced to 2 degrees and 8
degrees , respectively. By 2 months postoperative, the patient was complaining of
pain at the medial aspect of the distal phalanx of the hallux associated with
shoe pressure. The pain correlated both clinically and radiologically with the
exostosis at the base of the distal phalanx, and had become symptomatic only
after the hallux had been operatively realigned. At 6 months postoperative,
percutaneous exostectomy was undertaken to remove the exostosis. Pain relief was
complete, thereafter, and after 2 years of postoperative follow-up the patient
remained pain free. The clinical importance of a medial exostosis localized to
the base of the distal phalanx of the hallux must be taken into consideration
whenever hallux valgus correction is undertaken, and this is particularly
important whenever an Akin osteotomy is being considered. Level of Clinical
Evidence: 4