Purpose: The purpose of this study is to analyze the short- and long-term results of severe hallux valgus (HV) treated with a L-Reverse osteotomy. Methods: Patients treated with L-Reverse osteotomy for severe HV between the years 2006-2015 were included. Patients were evaluated preoperatively, at 3 months and 4 or more years postoperatively. Changes in the HV angle (HVA) and intermetatarsal angle (IMA) were measured. Clinical outcomes were assessed using the AOFAS score. Results: 28 patients were included. Pre-operative IMA changed from 18.1 degrees (18-18.9 degrees) to 7 degrees (6.3-8.5 degrees), and HVA from 38.5 degrees (34.5-41.3 degrees) to 10.0 degrees (8.4-11.8 degrees) at 3 month follow up (p < 0.005). Long term follow up was of 5.6 (4.9-6.4) years. IMA value was 7.5 degrees (6.1 degrees-8.1 degrees) and HVA was 10.1 degrees (6.7 degrees-16.3 degrees), with no statistical difference with initial correction (p = 0.14). Median AOFAS score was 92.7 (89-4-96.1). Conclusion: L-Reverse osteotomy can achieve correction of HV severe deformities with good outcomes in long term follow up. Level of evidence: III (c) 2022 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.