Forty two patients (45 feet) who underwent operative correction of acquired hallux varus were retrospectively evaluated. The causes of hallux varus included complications after hallux valgus surgery (36), trauma (3), rheumatoid arthritis (3), unknown (2), and osteoarthritis (1). The methods of surgical correction were determined by the underlying etiology, the age and activity level of the patient, and the site of primary deformity. Surgical corrections included medial soft tissue release alone (2), medial soft tissue release combined with tendon transfer (17), metatarsal osteotomy with (1) or without (1) additional tendon transfer, arthrodesis (17), and resection arthroplasty (7). The tendon transfers used included a split extensor hallucis longus (6), an extensor hallucis longus transfer in combination with interphalangeal joint arthrodesis (7), and an extensor hallucis brevis (4). All patients were evaluated at a mean of 3.8 years (range, 1-7 years) after surgery. Pain, problems with shoe wear, and metatarsophalangeal joint instability, if present preoperatively, were improved in all treatment groups. An algorithm for the operative management of hallux varus is presented.