Hallux Valgus / Bunion Deformity

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Lateral deviation of the great toe and medial deviation of the first metatarsal with Progressive incongruency of the first metatarsophalangeal (MTP) joint.

No single etiological factor can be implicated

  • Footwear
  • Heredity: Maternal transmission with variable penetrance
  • Other causes include
    • Hypermobility of the first metatarso cuneiform (TMT) joint
    • Generalized joint laxity
    • Neuromuscular disorders (including cerebral palsy and stroke



  • The primary symptom of hallux valgus is PAIN over the medial eminence.
  • Pressure from footwear is the most frequent cause of this discomfort.
    • Bursal inflammation
    • Irritation of the skin
    • Breakdown of the skin may be noted
  • Doesn’t always correlate with extent of deformity.


Conservative Management

  • Footwear Modification
    • Widen toe box
      • decrease lateral deviation of great toe
      • decrease inflammation and pain
    • Decrease heel height
      • prevent forward slide of the foot


Indications for surgery

  • Persistent symptoms
  • Progression of deformity
  • Failure of non-operative treatment
  • Cosmesis


Pre op and Post op


Osteotomies for Bunion Correction

  • Distal Metatarsal osteotomy – CHEVRON

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    Dorsal ledge for screw fixation treatment
  • Scarf Osteotomy: Z-step cut osteotomy

    Lateral shift of the metatarsal head
    Usually fixed with 2 screws
    Stable osteotomy

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  • Corrective arthrodesis of 1ST TMT joint – modified LAPIDUS Useful in severe IM angles

    Correction is by rotation
    Concurrent TMT arthritis
    – Hypermobile first ray
    – Flatfoot deformity – plantarflexion
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Sometimes an arthrodesis is necessary

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