The Chevron Osteotomy for Bunions

A Chevron osteotomy is a commonly done surgery to treat bunions on the feet. A bunion is an enlargement and a misalignment of the big toe which causes the big toe to turn toward the smaller toes. It often creates a bump at the base of the big toe that can become painful. There are many different surgical procedures that can be used to treat a bunion. Each of the procedures has a number of indications as to who it is most suitable for. With a Chevron osteotomy, the foot and ankle orthopaedic or podiatric surgeon cuts a "V" at the end of the long bone leading to the big toe (the metatarsal) and then rotates the end of the bone to straighten the big toe.

The indications for a Chevron osteotomy are generally for younger people who have no osteoarthritis in the joint and the amount of the deformity is considered mild to moderate. It is often the procedure of choice for young athletes, though elderly people with mild deformity can do well with this procedure. The key requirement is a joint that is congruent and without any disease inside the joint. The Chevron osteotomy is contraindicated if there is a significant amount of deformity or if the adductor muscles and ligaments are tight or there is an incongruity with the joint and osteoarthritis present.

The outcomes of bunion surgery following the Chevron osteotomy are generally pretty good. In a study by Hans-Jorg Trnka et al (in the Journal of Bone and Joint Surgery in 2000) they followed up 57 people who underwent a Chevron osteotomy with 5 year follow up. They reported that the range of motion of the big toe joint decreased between the initial assessment and the 2 year follow-up but was no worse at 5 years. They also reported no changes in the angle of the hallux valgus deformity between the 2 year and 5 year evaluations. Those over the age of 50 years did as well as younger patients which puts a question mark over this procedure primarily being indicated for younger people. The Chevron osteotomy procedure can damage the blood vessels near the base of the big toe, but these researchers found no cases of osteonecrosis of the metatarsal head at either the 2 year or 5 year follow-ups time frames. However, they did report that there was osteoarthritis of the big toe joint in 8 feet at the 2 year follow-up and in 11 feet at 5 yr follow-up.

As with any surgical procedure for a bunion, the Chevron osteotomy is a good option for the right indications and when done by a surgeon who is familiar with those indications and contraindications and has the technical skills to perform the surgery meticulously. As with any surgical procedures there are occasionally adverse outcomes, however with this procedure most of them are easily managed. If you need bunion surgery, you really need to take it up with the surgeon which procedure is best indicated for you and what the outcomes are most likely to be.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.