Performance of Distal and Proximal First Metatarsal Osteotomy in Hallux Valgus Surgery: A Systematic Review and Meta-Analysis

Background Hallux valgus is a common foot deformity. The combined prevalence is approximately 19%. Prevalence is higher in women and increases with age. The main surgical options are distal or proximal first metatarsal osteotomy. Comparative evidence remains heterogeneous and contradictory. Objective Evaluating the clinical performance of distal versus proximal first metatarsal osteotomy in patients with hallux valgus. Focus on pain, function, angle correction, and complications. Methods A systematic review and meta-analysis following PRISMA 2020. Searches were conducted in PubMed, Scopus, Cochrane Library, and Google Scholar for publications from 2015 to 2025. Keywords included hallux valgus, distal first metatarsal osteotomy, proximal first metatarsal osteotomy, chevron, scarf, AOFAS, VAS, HVA, IMA, MTP1 angle, union rate, recurrence, complication, comparative study. Only freely accessible full-text comparative studies were included. Data included sample size, techniques, clinical and radiological outcomes. Analysis used a random-effects model. Results Of the 350 records, 9 studies met the criteria. All techniques improved functional scores and reduced pain. VAS decreased from approximately 7 to 2. AOFAS increased by approximately 25 to 35 points. There were no significant differences between techniques for pain and function. Proximal osteotomy provided greater IMA correction in moderate to severe deformities. Distal osteotomy provided faster recovery. The complication rate was low and similar. Conclusion Both techniques are effective in improving function and reducing pain. The choice of technique depends on the degree of deformity and clinical goals. Further studies are needed for long- term evaluation.