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The aim of this work was to explore, how the operating technique of the first metatarsal osteotomy influences the forefoot conditions concerning pain, function and cosmesis. 327 patients were evaluated retrospectively and 34 patients prospectively following distal first metatarsal osteotomy. Examination methods included radiologic, pedographic and physical evaluations. Results suggest that the avoidance of shortening of the first metatarsal may decrease the onset of a postoperative transfer metatarsalgia on the middle rays. The magnitude of correction of either the hallux valgus angle or the 1-2 intermetatarsal angle did not influence the onset and magnitude of transfer metatarsalgia. Patients were more pleased with the appearance of their foot when the shortening of the first metatarsal was less intensive. A greater degree of correction of the hallux malalignment proved to lead to a higher level of patients' satisfaction with the foot appearance at each group. Pedography showed that the hallux loses its function, but the first metatarsal regains its role following the surgical procedure. An increased overall quality of gait dynamics at all the foot regions could also be detected.