A Chevron osteotomy is a common surgery to treat a bunion. A bunion (also known as hallux valgus) is a malalignment of the knuckle of the big toe. This malalignment causes the big toe to turn toward the smaller toes. It often creates a bump at the base of the big toe. Bunions are not always painful, but this deformity generally will get worse over time.
In a Chevron osteotomy, the foot and ankle orthopaedic surgeon cuts the end of the long bone leading to the big toe (metatarsal) and shifts the end of the bone to straighten the big toe. This procedure may be performed in conjunction with soft tissue adjustments around the joint. This osteotomy is mostly performed for mild to moderate bunion deformity. This bunion correction surgery relieves pain by straightening the big toe joint.
Bunion surgery may be needed if your bunion has a painful bump or skin irritation over the bump. You may have already tried non-surgical treatments such as splints, toe spacers, and wider shoes. These treatments may help pain, but they will not fix the bunion deformity. While bunion surgery may improve the cosmetic appearance of the foot by making the toes straighter, it should never be performed primarily for this reason.
Bunion surgery also should not be performed if the bunions are painless and do not cause problems. You should 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.
A Chevron osteotomy is performed as an outpatient procedure, meaning patients generally go home a few hours after surgery. The first toe joint is straightened 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
Your foot and ankle orthopaedic surgeon will make an incision on the inside of the foot over the joint of the big toe. After removing the inflamed fluid sac between the skin and bone, they will cut the end of the first metatarsal in a V-shape (chevron shape) and move the head toward the second toe. Your surgeon may use removable wires or a permanent plate and/or screws to hold the end of the bone in its new place. They will then shave the bony prominence on the inside of your foot to remove the painful bump.
Your surgeon may perform an additional procedure to tighten the soft tissue on the inside of the toe (first MTP capsulorrhaphy) and/or a procedure to loosen the soft tissue on the outside of the joint with the osteotomy (lateral release). Foot and ankle orthopaedic surgeons often use an X-ray machine in the operating room to verify that the toe is correctly aligned.
An X-ray image of a foot before surgery. The arrow shows a large bunion and crooked big toe.
An X-ray after Chevron osteotomy surgery. The surgeon has cut the bone in the big toe to correct the bunion and put in a screw to hold the bone in place. The toe is straight.
A dressing will be applied by your surgeon in the operating room, and you will be given a special shoe or boot. You may need to avoid putting weight on the foot or only put weight on the heel for a period of time determined by your surgeon. Dressings are applied to help 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 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. Limiting your activities will help to reduce pain and swelling and help prevent complications. Your surgeon may ask you to do range-of-motion exercises (bending the knee, hip, or ankle) to maintain flexibility and to avoid stiffness.
Stitches usually are removed two weeks after surgery. In some cases, your surgeon may recommend physical therapy.
Prolonged swelling and difficulty fitting in shoes are very common following foot surgery and may last several months. Compression stockings and physical therapy can be helpful in reducing the swelling.
All surgeries come with possible complications, including the 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.
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 foot and ankle orthopaedic surgeon. Together you can decide if surgery is best for you. Bunions do get worse over time, and as the bunion worsens, the type of surgery you need may change.
In some cases, immediately after surgery, your surgeon may allow you to put as much weight on your foot as you feel comfortable doing. In other cases, your surgeon may not allow you to put weight on your foot for a period of time or will allow you to walk on your heel only.
No matter how well your surgery may have gone, there is always the chance that your bunion may come back. 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 orthopaedic surgeon about revision surgery.
Original article by Ashish Shah, MD
Contributors/Reviewers: David Porter, MD; Elizabeth Cody, MD
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