Objective To explore the clinical efficacy of Scarf+Akin osteotomy(Scarf+Akin osteotomy，SAO) combined with first metatarsal head subsidence(FMHS) in the treatment of moderate to severe hallux valgus with metastatic metatarsalgia.Methods From October 2019 to October 2021，51 patients (62 feets) with hallux valgus were treated with SAO combined with FMHS，including 6 males and 45 females.The patients aged from 26 to 69 years，with an average age of (46.40±13.69) years.The images of hallux valgus angle (HVA)，intermetatarsal angle(IMA)，distal metatarsal articular angle (DMAA) and first metatarsal angle (FMA) shown in weight-bearing anteroposterior X-ray films of the affected foot before operation and at the last follow-up were analyzed and changes in study results were compared.The efficacy was evaluated by American Orthopedic Foot and Ankle Society(AOFAS) thumb joint scoring system.The visual analogue scale (VAS) was used to evaluate the pain of plantar callus.Results All 51 patients were followed up for 12 to 36 (19.85±4.26) months.No postoperative complications such as deformity recurrence，hallux varus，over-orthopedic，infection，etc.were found.In the last follow-up，there were 4 case(4 feet) with metatarsal bone metastases Pain，2 cases(2 feet)skin numbness at the edge of the medial incision，4 cases (5 feet) postoperative stiffness of the metatarsophalangeal joint.At the last follow-up，HVA，IMA，DMAA，and FMA were significantly improved compared with those before operation，and the difference was statistically significant (P＜0.001).The AOFAS score increased from preoperative (57.25±13.62) to (88.20±6.96)，and the difference was statistically significant (t＝－12.77，P＜0.001).Among them，52 feet were excellent，7 feet were good，and 3 feet were fair.The excellent rate was 95.16%.The VAS score decreased from preoperative (5.40±1.00) to (1.30±0.98)，and the difference was statistically significant(t＝17.96，P＜0.001). Conclusion SAO combined with FMHS can effectively treat patients with moderate to severe hallux valgus with metastatic metatarsalgia，and can significantly improve the symptoms of plantar pain in patients with good postoperative recovery，which is worthy of popularization.