100 patients with symptomatic hallux valgus were included in this randomized controlled two-by-two factorial design trial. Patients were randomized to undergo osteotomy with or without bony fixation, with post-operative regimens of either a soft cast or an elastic bandage to determine long-term outcomes over an average 7.9-year follow-up. The results indicated that total American Orthopaedic Foot and Ankle Society (AOFAS) scores improved in all groups over the first year, but slightly deteriorated from 1-year values by final follow-up. A similar trend was noted for pain, alignment and function subscores of the AOFAS. The AOFAS scores for function were better in the group treated without fixation and with an elastic bandage after 6 weeks post-operation; however, this difference was not maintained beyond this time point. When patients were stratified by severity of hallux valgus angle, it was observed that scores were significantly worse when preoperative hallux valgus angle exceeded 30 degrees.