Bunion or Hallux valgus The Surgery
Having read the "How does it occur section" you are now in a position to understand the principles of surgical correction of the deformity. To give a high chance of satisfactory outcome the (mechanical) factors driving the deformity should be overcome. This means replacing the first metatarsal next to the second metatarsal, thus realigning the tendons and reducing their deforming forces. This is well demonstrated by the following x-rays which shows how a scarf osteotomy has achieved this aim. 
The tissues on the second toe side of the deformity may become shortened and contracted and require a releasing operation(known as a lateral release) at the same sitting. There are many different operations available. At the Clinic we use three main corrective operations, depending upon the degree of deformity, for the pure bunion. In order of increasing deformity : 1. The Chevron osteotomy (3MB) Download movie (2.8MB)
2. The Scarf osteotomy(3.8MB) Download movie(3.5MB) 3.The Basal osteotomy The scarf and chevron osteotomies are fixed using cannulated DePuy Barouk screws.
The Basal osteotomy is performed using the Arthrex basal plate.
Additional procedures may be necessary
Despite directly reversing the pathology with the surgery detailed occasionally the big toe can retain an element of deformity at the end of the operation. Under these circumstances an additional osteotomy at the tip of the toe is performed which can correct the residual deformity. This is known as an Akin osteotomy and involves removing a small segment of bone from the inner side of the big toe itself. Can the big toe joint (MTP) always be left mobile?
If there is significant arthritic change associated with the deformity then an 'arthritis' operation such as a fusion may be more appropriate (see Hallux rigidus).
For very large (and generally fixed ) deformities again a fusion may be more appropriate (see Hallux rigidus). | 
