Hallux valgus is a common forefoot pathology often requiring surgical 
intervention for symptomatic relief. One complication of hallux valgus 
correction is flexible hallux varus. Iatrogenic flexible hallux varus often 
requires surgical repair; however, the most advantageous surgical procedure for 
repair of iatrogenic flexible hallux varus and their sustainability remains 
unclear. Therefore, we performed a systematic review to determine the 
sustainability of soft-tissue release with tendon transfer for the correction of 
iatrogenic flexible hallux varus. Studies were eligible for inclusion only if 
they involved failure of soft-tissue release with tendon transfer for flexible 
iatrogenic hallux varus. Eight studies met our inclusion criteria, seven of 
which were evidence-based medicine level IV studies and one was level V. A total 
of 52 patients, all female, involving 68 feet, were included. All studies 
included soft-tissue release of the first metatarsal-phalangeal joint capsule 
and 1 of the following procedures: Johnson transfer of the extensor hallucis 
longus tendon with arthrodesis of the hallux interphalangeal joint (41 feet); 
Hawkins transfer of the abductor hallucis tendon (9 feet); reverse Hawkins 
transfer (7 feet); Valtin transfer of the first dorsal interosseous tendon (7 
feet); and Myerson transfer of the extensor hallucis brevis tendon (4 feet). The 
weighted mean age of the patients was 50.4 years, and the weighted mean 
follow-up was 30.2 months. A total of 11 complications (16.2%) occurred. Of 
note, only 3 cases (4.4%) of recurrent hallux varus deformity developed, all of 
which occurred after Johnson transfer of the extensor hallucis longus tendon, 
with arthrodesis of the hallux interphalangeal joint. Our results support that 
sustainable correction of iatrogenic flexible hallux varus can be achieved with 
soft-tissue release of the first metatarsal-phalangeal joint combined with a 
variety of tendon transfer procedures. However, given the limited data 
available, potential areas for additional prospective investigation remain.