The ultimate goal of Hallux valgus (bunion) surgery is to restore the normal shape and biomechanics of the foot in order to reduce pain and allow the patient to return to wearing normal shoes. Though non-surgical treatments like using wider shoes, topical anti-inflammatories, and toe separators can be helpful, it will not make the bunion smaller and the goal is to help alleviate pain. Patients who continue to have pain, despite non-surgical treatment may need surgical intervention to the relieve pain. By using a minimally invasive percutaneous approach to treat Hallux valgus we can decrease surgery time and post-operative pain, allows us to operate both feet with very reproducible results and decreased probability of complications, and allows patients to weight bear right away (immediately post-op). Percutaneous bunion surgery involves performing an osteotomy (bone cut) of the distal metatarsal to correct the underlying deformity (it does not involve removing a bump).

Indications / Candidacy

Hallux valgus (bunion) is a frequent deformity of the first metatarsal joint (located at the base of the big toe). It occurs particularly in women where the joint of the big toe becomes bigger and sticks out. The skin over the bunion may be sore and red. Wearing tight, narrow shoes might cause pain and can make bunions worse. That being said, the primary cause of bunions is genetics and these foot deformities are often seen in many members of a same family. Pain is often felt medially (on the inside) and is the typical area where the shoe rubs.

Good Candidates for Percutaneous bunion surgery may have:

  • Pain associated with mild to moderate hallux valgus deformity (bunions)
  • Radiographs demonstrating a first intermetatarsal angle = 12 – 18 degrees, but the indications are expanding.

Treated Conditions

The Canadian Limb Lengthening Center offers a team of experienced surgeons, nurses and physiotherapists that make patients feel supported throughout their entire treatment process. Our ability to treat complex orthopedic conditions with a holistic approach gives our patients the best possible outcomes. We pride ourselves in providing highly specialized, expert care. To learn more about Hallux Valgus (bunions) follow the link below:


Forefoot Deformity Hallux Valgus

Surgical Technique

  1. A 2mm Kirschner wire/pin is inserted approximately 2-3mm from the medial corner of the nail of the great toe.
  2. A 3-5mm skin incision is made right below the bunion.
  3. Fluoroscopy will be used during surgery for correct positioning.
  4. A small bone-cutter is inserted, and the osteotomy (the breaking of the bone) is performed.
  5. There is displacement as needed to correct the bunion. This displacement is done using a special instrument (hallux wire passer, see picture).
  6. Stabilization of the bone is done by further inserting the 2 mm metal pin in the toe until the middle of the foot. This pin will remain in place for 3-4 weeks.
  7. Small dissolvable stitches are placed at the skin incision.
  8. Once the surgery is complete standard post operative bunion bandage is applied.


Percutaneous Bunion surgery will straighten the big toe and improve the fit of normal shoes. After surgery patients have more comfort walking and experience a better quality of life. Surgical scaring is minimal as this technique uses a smaller incision than previous methods. When patients perform consistent and proper post operative exercises, their full range of motion and function is typically restored as we did not touch the joint during the surgery.

Potential Complications

As with any surgical procedure, Percutaneous Bunion Surgery can have difficulties and complications. In most cases these occurrences are not threatening to the result or outcome of your surgery. Our team of specialists can address these concerns should they arise. Complications and side effects may include:

  • Bunion recurrence (3-4% over a lifetime)
  • Ongoing pain or stiffness, pain in the ball of foot
  • Infection at the pin site (superficial) and treated with oral antibiotics
  • Continued inflammation in the foot
  • Damage to sensory nerves to big toe
  • Wound-healing problems
  • Issues with bone healing
  • loss of movement in big toe

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre and post appointment dates
  • Make arrangements for personal care givers

Post-Operative Care

  • Patients are encouraged to weight bear as tolerated, wearing flat rigid sole sandal, as soon as they leave the hospital
  • Crutches are used for comfort and balance only after surgery and are often not needed
  • Dressing will be changed after 1 week at the first follow up appointment, and patients cannot get their feet wet until then

Patients who will undergo this procedure should read

Post-operative care

How to do the dressing

Follow-ups after surgery

  • Follow up appointments and repeat x-rays will be at 1 week, 4 weeks, 3 months, and 9 months after surgery
  • Patients will return at 4 weeks after surgery for removal of the metal pin. This is done in the clinic and although this causing patients a lot of anxiety it is not at all painful.
  • Following removal of the metal pin patients must do exercises to regain dorsiflexion of the first toe within the first 4-6 weeks after pin removal. This is of upmost importance,
  • An instruction sheet demonstrating how to do exercises correctly will be given

Case studies

60 year old lady with hallux valgus bunions
39 year old lady with Bialteral Hallux valgus (bunions)


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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.