Bunion Surgery (Hallux Valgus Correction)

Why this approach — at MOS

When I evaluate a patient for bunion surgery, my first task is measuring the deformity precisely on standing (weight-bearing) X-rays. The intermetatarsal angle (IMA) and hallux valgus angle (HVA) guide technique selection more than symptoms alone. A Chevron osteotomy works well for mild deformity with a stable TMT joint. For moderate-to-severe deformity — particularly when the first TMT joint is hypermobile or the IMA exceeds 15° — the Lapidus procedure addresses the problem at its mechanical origin. Trying to correct a large deformity with a distal osteotomy alone risks recurrence.

I use the Lapidus procedure frequently because it treats hypermobility of the first ray, which is an underlying driver of bunion formation in many patients. Modern low-profile locking plate systems allow early protected weight-bearing in a boot, addressing a historical concern about this procedure's longer non-weight-bearing period.

Intraoperative fluoroscopy confirms alignment before fixation is finalized. First-MTP range of motion is checked on the table — adequate dorsiflexion is a requirement before closure. Patients undergoing Lapidus can typically bear weight in a boot at 2 weeks and transition to a wide shoe at 6–8 weeks.

Bunion surgery is associated with high patient satisfaction when the correct technique is matched to the deformity severity. The commonest cause of suboptimal results is under-correction — I prefer to slightly over-correct alignment rather than leave residual deformity.

Who is a candidate?

Indications

• Persistent pain at the bunion site that limits walking, exercise, or daily activity
• Intermetatarsal angle greater than 13° (mild–moderate deformity) or greater than 20° (severe deformity)
• Failure of 3–6 months of conservative measures including wide-toe shoes, orthotics, and anti-inflammatory medications
• Progressive deformity with secondary involvement of the second toe (crossover toe, hammer toe)
• Skin breakdown or ulceration over the medial eminence (especially in diabetic patients)
• Significant arthritic joint changes limiting motion

Contraindications

• Active infection in the foot or surrounding tissue
• Peripheral vascular disease with inadequate blood supply for wound healing
• Poorly controlled diabetes (relative contraindication — must be optimized pre-operatively)
• Active inflammatory arthropathy flare (e.g., rheumatoid arthritis) — timing must be coordinated with rheumatology
• Patients who are not medically cleared for regional or general anesthesia
• Purely cosmetic motivation without functional impairment — patient counseling should address expectations

Conservative Treatment First

Surgery for bunions is an elective procedure. Before recommending an operation, Dr. Feldman explores every reasonable non-surgical strategy with each patient. Wide, accommodating footwear with a deep toe box is the foundation of conservative care — many patients find this alone reduces pain significantly. Silicone toe spacers and bunion pads reduce friction between the bunion and the shoe. Custom or prefabricated orthotics offload pressure from the metatarsal head and can slow deformity progression in younger patients.

Anti-inflammatory medications (oral NSAIDs or a cortisone injection into the MTP joint) are used for acute flares of pain. Physical therapy targeting the intrinsic foot muscles and first-ray range of motion can help maintain function. It is important to understand that no conservative measure reverses the underlying bone deformity — they manage symptoms. Surgery is recommended when symptoms are severe enough to affect quality of life and conservative treatment has provided inadequate relief after a sustained effort.

The procedure

What Is Bunion Surgery (Hallux Valgus Correction)?

Bunion surgery (hallux valgus correction) realigns the big toe joint by removing the bony bump and repositioning the first metatarsal bone. The technique used depends on how severe the deformity is. Most patients bear weight in a protective boot within days and return to normal shoes in 3–4 months.

A bunion — known medically as hallux valgus — is not simply a growth on the side of the foot. It is a mechanical deformity in which the first metatarsal bone drifts inward (medially) while the big toe angles outward toward the second toe. This widens the forefoot, pushes the metatarsal head against shoes, and eventually causes pain, skin irritation, and arthritic changes in the first metatarsophalangeal (MTP) joint.

Bunions are progressive. Without treatment, the deformity typically worsens over years, and a second toe can be pushed out of position by the crowding big toe. Surgery does not simply shave the bump — it corrects the underlying bone alignment. Multiple surgical techniques exist, and the right one depends on the degree of deformity (measured by the intermetatarsal angle on weight-bearing X-rays), the flexibility of the joint, the patient's activity level, and bone quality.

What Happens During Bunion Surgery?

Bunion surgery at Maryland Orthopedic Specialists is performed at an ambulatory surgery center as an outpatient procedure. You arrive, complete pre-operative preparation, and go home the same day.

Anesthesia: An ankle block is performed — local anesthetic is injected around the nerves just above the ankle, numbing the entire foot. Light sedation is typically given for comfort during block placement. This approach avoids the risks of general anesthesia and provides several hours of post-operative pain control.

Positioning: You lie on your back with the foot and lower leg prepped and draped. A pneumatic tourniquet on the calf temporarily reduces bleeding in the surgical field.

Technique — Lapidus Procedure (moderate-to-severe deformity, IMA ≥ 15°): The Lapidus procedure corrects hallux valgus at its origin — the first tarsometatarsal (TMT) joint. A medial incision is made along the first ray. The first metatarsal is mobilized, the TMT joint cartilage is removed, and the metatarsal is rotated and shifted laterally to restore normal alignment. The joint is then fixed with a low-profile titanium plate and screws. A separate incision at the MTP joint releases the tight lateral soft tissues (lateral release), and the medial eminence (the "bump") is resected. The MTP joint capsule is tightened medially to keep the big toe straight.

Technique — Chevron/Austin Osteotomy (mild-to-moderate deformity, IMA 13–18°): A V-shaped (chevron) cut is made in the head of the first metatarsal. The head is shifted laterally, correcting alignment, then held with one or two screws. The medial eminence is resected and the soft tissues are balanced.

Technique — Scarf Osteotomy (moderate deformity, versatile correction): A long Z-shaped cut along the length of the metatarsal allows three-dimensional correction — the bone can be shifted, rotated, and shortened or lengthened as needed. Fixed with two screws.

Closure: The incision is closed in layers, a sterile dressing and surgical shoe or boot is applied, and you are moved to recovery.

Recovery Room: Nursing staff manages initial pain, and you are discharged home within 1–2 hours once comfortable and stable. Crutches or a knee scooter are provided for non-weight-bearing or restricted weight-bearing as directed.

Recovery timeline

Frequently Asked Questions