Question
A 55 year old woman has a painful bunion that rubs in shoes despite wide footwear.
- What radiographic measurements would you make?
- What are the surgical options and how would you choose?
- What are the complications?
Answer
Radiographic measurements
- Weight bearing AP and lateral views
- Hallux valgus angle, normal under 15 degrees
- First to second intermetatarsal angle, normal under 9 degrees
- Distal metatarsal articular angle and joint congruency
- Sesamoid position, first ray hypermobility and arthritis of the MTP joint
Surgical options
- Mild deformity (IMA under 13 degrees), distal chevron osteotomy
- Moderate to severe deformity, scarf or proximal metatarsal osteotomy
- Hypermobile first ray or severe deformity, Lapidus first TMT fusion
- Akin osteotomy for residual interphalangeal valgus
- Arthritic joint or salvage, first MTP fusion
- Minimally invasive osteotomies are an option in selected patients
Complications
- Recurrence, the most common
- Hallux varus from over correction or excess lateral release
- Avascular necrosis of the metatarsal head
- Transfer metatarsalgia from shortening or dorsal malunion
- Stiffness and dorsomedial cutaneous nerve injury
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.