In about 1934, several patients operated on for hallux valgus in the preceding few years began to appear with recurrence of deformity. The obvious common finding in all these patients was metatarsus primus varus. Other patients operated on during the same period and by the same method had satisfactory results. None of these had metatarsus primus varus. It was concluded that metatarsus primus varus was the primary deformity and that failure to evaluate its significance and to correct it was responsible for recurrence of hallux valgus.
To verify the above conclusions an x-ray study of normal asymptomatic feet was made. A group of employees in a large industrial plant were asked if they had ever had any foot trouble. If their answer was "no," x-rays of their feet were made. On completion of the survey it was apparent that not all were strictly frank, since there were nine in the