What Is a Bunions (Hallux Valgus) Osteotomy?

A hallux valgus osteotomy involves straightening the big toe to restore the normal alignment of the toe.

Hallux valgus, also known as a bunion, is the most common misalignment of the big toes. It is a deformity in which the big toe deviates toward the small toes. In a severe type of deformity, the big toe goes below or above the second toe.

In a hallux valgus deformity, the joint connecting the bones of the foot and toe (metatarsophalangeal joint) are overextended, and as a result, painful arthritis of the big toe (hallux rigidus) can develop.

The protruding bunion at the metatarsophalangeal joint becomes inflamed and painful.

A hallux valgus osteotomy involves straightening the big toe to restore the normal alignment of the toe. 

The different types of osteotomy are as follows:

• Chevron osteotomy
• Scarf osteotomy
• Ludloff osteotomy
• Akin osteotomy

Surgery is required in the following cases to:

• Improve cosmetic appearance
• Correct painful misalignment
• Correct mobility restricting a bunion
• Correct the deformity before it worsens
• Overcome failure of the conservative measures to relieve symptoms

A hallux valgus osteotomy should be avoided in patients with

• Poor wound-healing
• Poor blood flow
• Advanced arthrosis of metatarsophalangeal joint (wear and tear of joints)
• Gout
• Tightened or stiff muscles
• Unrealistic expectations

Before the surgery:

• The patient will be given painkillers on the day of the surgery.
• The physician will choose and give a local or general anesthetic to the patient.
• The physician will place triangular support under the patient’s knee to keep their foot flat on the table.
• The physician will place the patient’s foot over a bump of double-brick height and shape to clear it from the other foot.

During the surgery:

The procedure depends upon the type of osteotomy selected by the physician. The most commonly performed osteotomies are described further below:

• Chevron osteotomy: A V-shaped wedge is removed from the part of the big toe with the joint—also known as the metatarsal head. An incision is made at the back of the foot. This technique is useful for moderate hallux misalignments. The metatarsal head is aligned to the default position and secured with titanium screws.
• Scarf osteotomy: During the procedure, a Z-shaped wedge is sawed out at the side of the big toe. The metatarsal head is aligned to the default position and secured with titanium screws.
• Akin osteotomy: In this technique, a wedge-shaped wafer of the bone is sawed out at the side of the big toe.

The wound is irrigated and closed with stitches. 

After the surgery:

• The patient should elevate their foot and place ice packs on the foot to minimize pain and swelling.
• The foot will be covered in a special bandage. The stitches will be removed after about 12 days. The patient will have to wear special shoes for four weeks, which takes the pressure off the forefoot. 
• It takes about three to six weeks for complete healing. Post-procedure infection may be observed with this surgery.