Among foot pathologies, Hallux Valgus is definitely the most frequent. Its characteristics are well known, the first element being the medial bursitis of the 1st Metatarsophalangeal joint (painful inflammation that leads to intolerance for footwear). The deformation of external toes (especially mallet fingers) is also very frequent. It is fostered and made worse by the deviation of the hallux, just like secondary metatrsalgies that are often associated to it (plantar pain). The causes of Hallux valgus are many, yet not completely known. The main cause seems to be a biomechanical problem: an abnormal subtalar joint pronation (in other words: Flat foot) that leads to an overloading and instability of 1st metatarsal bone and, consequently, of the 1st metatrsophalangeal joint. Among other reasons for hallux valgus are: rheumatic pathologies (rheumatoid arthritis and gout, for example), genetic pathologies with ligament relaxation (Marfan s., Down s.), and traumatisms. Treatment is mainly surgical and the techniques used are many. Keller's method, which was conceived at the beginning of the '900s, was particularly famous in the past. It consisted in the resection of the medial esostosys of the first metatarsal bone and of the base of the first phalanx. Then, the correction achieved is maintained thanks to the medial suture of the articular capsule. Picture 1. KELLER's method: resection of the medial esostosys of the 1st metatarsal bone and of the base of the hallux's first phalanx. The main flaw of this technique is the impact on the metatarsophalangeal joint (resection of the base of the first phalanx) and the consequent loss of pushing force from the hallux in the last phase of the step. In the last few decades, therefore, other methods have gained importance, especially osteotomies of the 1st metatarsal bone. At the moment, in our Operative Unit, various types of such osteotomies are performed systematically to correct the hallux valgus condition: in particular, AUSTIN METHOD (OR CHEVRON), and REVERDIN-GREEN METHOD. AUSTIN's osteotomy is performed by using the special saw, at the level of the neck of the 1st metatarsal bone, with a distal apex V section (picture 2) capable of ensuring a certain degree of stability. Picture 2. AUSTIN osteotomy: V section of the neck of the 1st metatarsal bone. The epiphysis is later dislocated laterally and fastened with Kirschner's wire or a small screw. The cephalic bone fragment is moved laterally, and often in a plantar way, in order to correct the deformity of the 1st metatarsal bone, which is at the base of the hallux valgus condition. The osteotomy is fixed with a steel wire or a small screw.   REVERDIN-GREEN osteotomy is used for the same purposes (to correct the deviation of the 1st metatarsal bone). The section is a little different so that, by removing a medial-based bone wedge, it also allows a better result with the cartilage of the 1st m. joint. Picture 3. REVERDIN-GREEN osteotomy: section of the neck of the metatarsal bone with the removal of a medial-based bone wedge, to allow the correction of the cartilage of the joint. The epiphysis is later moved laterally and fixed. This is a radiography of an example of surgical correction:   These kinds of osteotomy have various advantages: first of all they preserve the joint, as opposed to what happens with Keller's method. Less postoperative pain, since it is not necessary to detach the tendinous insertions from the base of the 1° phalanx. This is why in the past hallux valgus surgeries were procrastinated and preferred for elderly patients, whereas osteotomies are suitable for young patients. Moreover, a successful surgical correction of the deformity through Keller's method depended on the quality of the articular capsule, which is often poor and therefore not suitable for this purpose: this is why the the relapse of the valgus condition is so frequent. Osteotomy, instead, "structurally" modifies the bone and, according to statistics, relapses are in the range of only 10-15%. Patients who have highly damaged joint cartilage have to undergo arthrodesis surgery of the metatarsophalangeal joint (joint fixation), which guarantees a good degree of correction and stability of the 1st ray. Such operations are usually performed with local anaesthesia (injections are done in the area surrounding the instep, in order to anaesthetise the major nervous groups) and are carried out with Day Hospital procedures. A few days before the operation, the patient is called to the hospital to carry out all the necessary diagnostic tests in pre-hospitalisation regime, with no expenses on his/her part. The tetanus vaccine must have been applied. The patient enters the hospital on the very morning of the operation and can leave a few hours after the surgery. Post-operative treatment envisages an oral antibiotic therapy to be followed for a few days, the intake of analgesic medication and the following of the anti thrombo-embolism prophylaxis. The patient can walk immediately, by unloading the weight from the forefoot thanks to a special TALUS-type shoe he/she will have to wear for about a month. After this period of time, the patient will be able to wear normal shoes again. Usually, a special rehabilitation program is not necessary and simple mobility exercises for the 1st metatarsophalangeal joint that the patient can do on his/her own should be sufficient.