Background: Currently, correction of the first intermetatarsal angle associated with hallux valgus is done using two main categories of surgeries either a distal or a proximal first metatarsal osteotomy. The osteotomy–sparing technique using TigthRope ®device was developed to manage hallux valgus avoiding osteotomy complications. Our hypothesis was that osteotomy sparing technique using TightRope® implant would be suitable for moderate hallux valgus in young adult patients with strong larger bones giving good results with minimal complications. Methods: 26 male patients (30 feet) with age range 18–35 years (average 27.04 ± 4.6) with moderate hallux valgus deformity were managed with osteotomy-sparing method. All patients were assessed clinically using the visual analogue scale (VAS) and American Orthopedic Foot and ankle score (AOFAS) and radiological using hallux valgus angle (HVA), first inter metatarsal angle (IMA) and sesamoids position. P value<0.05 was statistically significant. Results: The mean follow up time was 19.5 ± 4.1 (12–27) months. The mean IMA, HVA and AOFAS score improved from 14. 2 ± 2.8°, 33.4 ± 7.6° and 42.6 ± 6.3 points preoperatively to 8.2 ± 2.3°, 13.6 ± 5.4° and 85.8 ± 6.8 points postoperatively, respectively. All were statistically significant. Superficial infection occurred in one case and overcorrection in another with no other complications. Conclusion: Osteotomy-sparing technique using TightRope device is effective in the management of moderate hallux valgus provided that proper patient selection, adequate surgical technique, and proper postoperative protocol are followed. 1. Introduction Hallux valgus (lateral deviation of the great toe) is not a single disorder but it is a complex deformity consists of medial angulation of the first metatarsal and lateral deviation of the hallux, with element of rotation (usually pronation) in addition to bunion formation on the medial aspect of the first metatarsal head.1 Females are more commonly affected than males. Wearing of narrow shoes with high heel is an important extrinsic factor in the development of hallux valgus.2 Many theories have been proposed for the pathogenesis of hallux valgus including genetic predisposition, structural abnormalities, ligamentous hyperlaxity and muscle imbalance.3 The controversy continues over which deformity is the essential in hallux valgus: