Percutaneous hallux valgus surgery has evolved, with the fourth generation involving a metaphyseal extracapsular transverse osteotomy and akin osteotomy. Correct patient positioning and theater ergonomics are essential to reduce unnecessary fluoroscopy and capture accurate radiographs before osteotomy/wire placement. The position of the head can influence the risk of recurrence. Screw position must be scrutinized to prevent plantarflexing or dorsiflexing of the osteotomy and reduce the risk of postoperative fracture. A lateral release may be required based on intraoperative assessments. Postoperatively, patients follow a protocol that allows accelerated rehabilitation in a controlled fashion.