Procedures
Surgical correction of hallux valgus addresses the underlying angular deformity of the first metatarsophalangeal joint, rather than the visible prominence in isolation. Technique selection is determined by the grade of deformity established on weight-bearing X-ray, with the objective of a stable, functionally sound correction and a clearly defined recovery pathway.
Correction of hallux valgus is achieved through an osteotomy — a controlled surgical cut through the first metatarsal bone, and frequently the proximal phalanx of the big toe as well — that allows the bone to be repositioned and the intermetatarsal and hallux valgus angles to be restored toward normal alignment. The repositioned bone is then secured internally, typically with titanium screws, allowing the osteotomy to heal in corrected alignment. This distinguishes true surgical correction from simple resection of the bony prominence (an isolated bunionectomy), which removes the visible bump without addressing the angular deformity of the joint and carries a substantially higher rate of recurrence.
Surgery is considered when symptoms are persistent, functionally limiting, or progressing despite appropriate non-surgical management, and is planned according to the grade of deformity established on weight-bearing imaging.
The hallux valgus and intermetatarsal angles measured on that imaging determine not only whether surgery is appropriate, but which surgical technique is best matched to the specific deformity — the basis for the technique selection described below.
Surgical technique
The combined Scarf and Akin osteotomy is among the most widely used techniques internationally for correction of mild to moderate hallux valgus. The Scarf osteotomy is a Z-shaped cut through the shaft of the first metatarsal, designed so that the two bone surfaces retain broad contact even after the metatarsal head is shifted laterally — this geometry is what allows a precise, multi-planar correction of the intermetatarsal angle while maintaining a large, stable healing surface, in contrast to simpler osteotomy patterns that permit less controlled correction. The Akin osteotomy is a complementary closing-wedge cut at the base of the proximal phalanx of the big toe itself, used to correct any residual angulation of the toe that persists once the metatarsal has been realigned. Used together, the two corrections address both components of the deformity, and are secured internally with small titanium screws to allow bony union in corrected alignment.
Deformity grade, established on the pre-operative weight-bearing X-ray described on the Bunions (Hallux Valgus) page, determines the specific osteotomy pattern and degree of correction required — more severe deformity, or instability at the joint immediately behind the first metatarsal, may require a different or more extensive technique than the standard Scarf and Akin combination. This is assessed and discussed individually, rather than applied as a single default approach to every case.
In appropriately selected cases of mild to moderate deformity, a minimally invasive (percutaneous) approach may achieve an equivalent correction through a series of small incisions rather than a single open approach. This is one available technique rather than a universal solution, and its suitability depends on the specific deformity pattern rather than patient preference alone.
Bunion surgery is typically performed as a day procedure or with a short overnight stay, under regional anaesthesia (a nerve or ankle block) combined with light sedation, or general anaesthesia depending on individual circumstances and preference. Operating time is generally under an hour, though this varies with the complexity of the deformity and whether additional procedures — such as correction of an associated lesser toe deformity — are performed at the same time.
Bone healing at the osteotomy site follows a defined biological timeline, and the recovery pathway is structured around it. Timeframes vary between individuals and depend on the specific technique used:
Protected weight-bearing in a rigid-soled post-operative shoe, which limits load through the healing osteotomy while allowing walking. Wound care and elevation to manage post-operative swelling.
Radiographic union of the osteotomy is typically established by this stage, allowing gradual transition back to normal, wider footwear as swelling settles.
Continued resolution of swelling and improvement in joint flexibility, with most patients returned to regular activity — though residual swelling, particularly later in the day, can persist longer in some individuals.
These are general ranges based on typical bony healing timeframes, not guarantees. Recovery depends on the specific procedure performed, the severity of the original deformity, and individual healing.
As with any surgical procedure, bunion correction carries general surgical risks including infection and delayed wound healing. Procedure-specific risks include stiffness at the first metatarsophalangeal joint, altered sensation around the incision related to small cutaneous nerve branches, transfer of load to the adjacent lesser metatarsals (transfer metatarsalgia), and — particularly where deformity grade was more severe or underlying joint laxity persists — recurrence of the deformity over time. These risks, and their relative likelihood for the specific technique planned, are discussed in detail as part of pre-operative consultation.
Most patients return to normal, comfortable footwear by approximately 6 weeks, once radiographic union of the osteotomy is established. Return to sport and higher-impact activity is guided by individual progress — including confirmed bony healing on follow-up imaging — rather than a fixed calendar timeframe, and is discussed on a case-by-case basis during post-operative review.
Most patients return to normal footwear by around 6 weeks, once the osteotomy has achieved radiographic union, with continued improvement in swelling and flexibility over 3 to 6 months. Individual recovery varies with technique and deformity severity.
Discomfort is expected in the first one to two weeks and is generally well managed with standard post-operative analgesia and activity modification. Expected pain levels and management are discussed in detail prior to surgery.
Both achieve the same underlying goal — correction of the intermetatarsal and hallux valgus angles — but keyhole (minimally invasive) technique is performed through several small percutaneous incisions, while open technique uses a single, larger incision providing direct visualisation of the osteotomy. Suitability depends on the specific deformity pattern established on imaging, not a general preference for one approach over the other.
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