Bunion Surgery Is Not One Operation
Patients sometimes speak about 'having the bunion operation' as though there were one standard procedure. In reality, numerous operations are available because hallux valgus occurs in different forms and severities. The challenge is not simply performing an operation well; it is choosing an operation that addresses the actual problem.
Start With the Patient's Symptoms
Surgery should have a clinical purpose. Pain over the medial prominence, joint pain, difficulty with footwear, lesser-toe crowding and functional limitation may all contribute to the decision. A radiographically impressive deformity that causes little or no difficulty does not automatically require surgery.
Examination Adds Information X-rays Cannot
The examination assesses joint motion, tenderness, reducibility of the deformity, skin and neurological status, lesser-toe problems and the way the foot functions. These findings can change the interpretation of the radiographs and influence the surgical plan.
Use Imaging to Define the Structure
Weight-bearing X-rays are particularly useful for assessing hallux valgus. They allow the clinician to evaluate alignment, joint congruity, arthritis and associated structural findings. Measurements such as the hallux valgus angle and intermetatarsal angle can contribute to planning, but they are not the entire decision.
Consider the Joint
A joint-preserving osteotomy makes most sense when there is a joint worth preserving. Significant arthritis, severe stiffness or joint destruction can shift the balance towards a different procedure.
Match the Procedure to the Deformity
For many mild to moderate deformities with a suitable joint, an Austin/Chevron osteotomy can be an excellent option. Other patients may require a different osteotomy, a Lapidus-type procedure, first MTP fusion or another strategy. The objective is adequate correction without performing unnecessary surgery.
Include the Patient in the Decision
Occupation, sporting goals, footwear requirements, home circumstances, available support and tolerance for the recovery period all matter. Shared decision-making allows the patient to understand not only the proposed operation but also the alternatives, limitations, risks and expected rehabilitation.
Avoid Marketing-Led Procedure Selection
Patients increasingly encounter terms such as keyhole, minimally invasive, scarless, 3D, correction systems and other branded approaches. Some techniques are valuable developments, but a marketing label does not establish that a procedure is best for a particular foot. The underlying principles of diagnosis, correction, stability and healing remain essential.
My Approach to the Austin/Chevron Procedure
The Austin/Chevron osteotomy is a procedure I commonly perform because it is suitable for many of the bunion deformities I assess. However, the decision is made after clinical assessment and imaging. Where the deformity or joint pathology indicates that another operation is more appropriate, that should be discussed rather than trying to make one procedure fit every patient.
The Central Message of This Chapter
The Austin/Chevron osteotomy is best understood as one well-established tool within a broader approach to bunion surgery. Good treatment begins by understanding why the patient has symptoms, defining the deformity and then selecting a procedure that addresses those findings while respecting the patient's goals.