Bunion Surgery




A bunion (hallux valgus) is a deformity of the bones in the first metatarsal. The primary indication is when the big toe begins to tilt into the toes beside it and the telltale bump develops at the base of the big toe.

Why Surgery?

Bunion surgery is usually only considered for severe cases that cannot be treated through non-surgical means. There are many different procedures that your surgeon may use but they all more or less have the same goals: to minimize or remove the bony protrusion, realign the bones, and reduce the deformity, all of which will ultimately reduce bunion pain.

Let’s have a closer look at the details of the procedures involved:

Tendon and Ligament Repair Pertaining to the Big Toe

It often happens that tendons and ligaments on one side of the toe are tighter than those on the opposing side. This usually causes the big toe to be gradually pulled out of position as the tighter tissues are able to pull the big toe toward the dominant tendons and ligaments.

Tendon and ligament repair is performed to shorten the lax tendons and lengthen the tight ones. It is often performed in tandem with an osteotomy, which involves cutting the bone to change its shape and/or realign it.


This procedure is usually reserved for severe bunions and/or arthritis or when all other procedures have failed. Arthrodesis involves removing damaged joint surfaces from the connecting bones. Screws, wires or plates are then introduced to hold the two surfaces in alignment until the bones knit together. This naturally means that there will be reduced flexibility in the big toe as the two bones of the first metatarsal will have fused together.

An exostectomy entails the removal of the bone protrusion on the joint of the bone and is used only to treat a protrusion that does not entail an inward drift of the first metatarsal. It is not a very effective procedure as it rarely corrects the underlying cause of bunion formation.
Resection Arthroplasty

Surgery of this type is performed primarily on older patients who either have a history of bunion surgery or who are suffering from severe arthritis. This procedure involves the removal of damaged joint tissues, and a flexible ‘scar joint’ forms in the same place, which means that ‘hardware’ such as screws or plates needn’t be used to realign or stabilize the joint.

An osteotomy requires the bone to be surgically cut for reshaping purposes before the bones and/or joints are realigned. Osteotomy refers to what happens, but where it happens is up to your surgeon. This procedure often involves the shaving or removal of the hallmark bony protrusion that is usually associated with bunions.

The aim of this operation is to realign and strengthen the big toe, and the bones must be held in place while the incisions heal. Screws, wires, plates and staples are the most common tools used to keep the bones stable. A cast, or perhaps a post-operative shoe, is usually worn after the surgery has been completed.

The ‘chevron’ osteotomy is usually performed on mild bunions while the ‘scarf’ osteotomy is reserved for more severe cases.


There are several available techniques that can used for bunion surgery, but as you can see there are several factors that podiatrists and orthopaedic surgeons will apply when making the decision.

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