There are many bunion operations because hallux valgus is not identical in every patient. The procedure must address the location and degree of deformity rather than simply remove the prominent bump.
Weight-bearing X-rays help assess the hallux valgus angle, intermetatarsal angle, sesamoid position, joint congruency and signs of arthritis. Clinical examination evaluates joint mobility, soft-tissue balance, first-ray stability and associated deformities.
For many appropriately selected mild-to-moderate bunions, I commonly use an Austin or Chevron osteotomy. This involves a controlled V-shaped cut near the head of the first metatarsal so the bone can be repositioned and stabilised. It may be combined with soft-tissue balancing or an additional toe procedure when required.
A severe deformity, significant instability, substantial arthritis or previous failed surgery may require a different operation. Using the same procedure for every bunion would not be appropriate.