Chevron Osteotomy

​What is a bunion?

A bunion (also known as hallux valgus) is a misalignment of the knuckle of the big toe. This misalignment causes the big toe to turn toward the smaller toes. It also often creates a bump at the base of the big toe. Bunions are not always painful, and this deformity will generally increase over time.
 

What are the goals of bunion correction surgery?

Bunion correction surgery relieves pain by restoring normal alignment of the first toe joint. This procedure should not be performed so someone can wear fashionable shoes, as this may cause the bunion to come back. The surgery consists of realignment of the bones, soft tissue procedures and/or joint fusions. An orthopaedic foot and ankle surgeon can determine which procedure may be right for you.
 

What is a Chevron osteotomy?

A Chevron osteotomy is a common bunion correction surgery. The orthopaedic surgeon cuts the end of the long bone leading to

Figure 1: Surgical photo showing the tip of the ​first metatarsal with a V-shaped cut.​
the big toe (metatarsal) and slides it toward the outside of the foot to correct the misalignment. This procedure may also be performed in conjunction with soft tissue tightening or loosening around the joint. This osteotomy is mostly performed for mild to moderate bunion deformity.
 

What signs indicate surgery may be needed?

Bunion surgery may be needed if your bunion has a painful bump or skin irritation over the bump. You may have already tried non-operative treatments such as splints, toe spacers and wider shoes without relief from the pain. While bunion surgery may improve the cosmetic appearance of the foot, it should never be performed primarily for this reason.
 

When should I avoid surgery?

Bunion surgery should not be performed if the bunions are painless and do not cause problems. You should also avoid surgery if you have an active infection, poor blood flow or uncontrolled diabetes. If you have a severe deformity or extensive arthritis in the affected joint, a Chevron osteotomy may not be the correct procedure for you.
 

General Details of Procedure

A Chevron osteotomy is performed as an outpatient procedure, meaning patients generally go home a few hours after surgery. The first toe joint is realigned and the painful bump at the base of the big toe is filed down. This generally relieves the pain associated with the bunion and gives the foot a more normal appearance.
 

Specific Techniques

An incision is made on the inside of the foot over the joint of the big toe. The inflamed fluid sac between the skin and bone is
Figure 2: Intraoper​ative X-ray ​taken during a Chevron osteotomy
removed. The end of the first metatarsal is cut in the shape of a V (figure 1) and moved. In some cases, the orthopaedic surgeon may use removable wires or permanent screws to hold the end of the bone in its new place. The bony prominence on the inside of the foot is shaved to remove the painful bump. An additional procedure to tighten the soft tissue on the inside of the joint is performed with the osteotomy. Sometimes an additional procedure to loosen the soft tissue on the outside of the joint is performed at the same time. Orthopaedic surgeons often use an X-ray machine in the operating room to verify that the alignment of the foot has been corrected (figure 2).
 

What happens after the surgery?

A dressing will be applied by your surgeon in the operating room, and you will be given a special shoe. You will have to avoid putting weight on the foot or only put weight on the heel for a period of time determined by your surgeon. The dressings are applied to hold the big toe in position, so you should not change the dressings unless told to by your surgeon. Also, the dressings cannot get wet.
 
You will be asked to elevate your foot to chest level for the first few weeks after surgery. You may need to use crutches or a walker the first few days after this surgery. These help to reduce complications as well as pain and swelling. Your doctor may ask you to do range-of-motion exercises (bending the knee, hip or ankle) to maintain flexibility and to avoid stiffness.
 
Stiches are usually removed two weeks after surgery. Your surgeon will discuss whether physical therapy is needed.
 
Prolonged swelling and challenges with reasonable shoewear are very common following foot surgery and may last several months. Compression stockings and physical therapy can be helpful in reducing the swelling.
 

Potential Complications

There are complications that relate to surgery in general. These include risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
 
Potential complications with Chevron osteotomy include the bone failing to heal or disruption of the blood supply to the cut bone. Surgically corrected bunions have the potential for recurrence, even when the procedure was performed correctly. Patients can help prevent this by following their doctor's post-operative instructions.
 

Frequently Asked Questions

Is it better to have my bunion fixed now, or should I wait?
When the pain of a bunion interferes with daily activities or shoe modification options don’t help you, it's time to discuss surgical options with your orthopaedic surgeon. Together you can decide if surgery is best for you.
 
How long will I have to be off of my foot?
For a brief period of time after surgery, you should not put weight on the foot. In some cases, your surgeon may allow you to walk on your heel only.
 
What do I do if my bunion comes back?
No matter how well your surgery may have gone, there is always the chance that your bunion may recur. Often the new bunion is not painful and surgery is not needed. However, if your bunion comes back with pain, then you should talk to your foot and ankle surgeon about revision surgery.
 
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.
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