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1. Bunionectomy Procedures

The simple cutting away of the protruding bone to reduce the bunion bump.

1925

Silver bunionectomy

Technical Concept

Bone-shaving to narrow the forefoot

Shortcomings

For temporary relief from mild bunions

2. Osteotomy Procedures

The 'break-n-shift' concept that realigns and reshapes the first metatarsal bone from in various locations.

Distal Osteotomy

A cut in the distal third section of the first metatarsal, easier to perform, for mild to moderate bunion corrections.

1880

Reverdin osteotomy

Technical Concept

A distal close-wedge resection to redirect big toe

Shortcomings

Realigns the big toe but not the first metatarsal bone

1958

Mitchell osteotomy

Technical Concept

A step-cut, controlled correction, good stability

Shortcomings

Excessive bone shortening, increased metatarsalgia risk

1963

Wilson osteotomy

Technical Concept

Sagittal oblique cut, sliding for flexible correction

Shortcomings

Unstable, poor correction control, shortening and metatarsalgia risk

Triple-plane (3D) osteotomy

Technical Concept

Correction in all 3 planes

Shortcomings

Technically very difficult and unproven benefits

1979

Chevron osteotomy - distal

Technical Concept

Inverted "V" cut, good stability, less bone loss and shortening

Shortcomings

Possible metatarsal head bone death, correction limitation

Proximal Osteotomy

For greater bunion deformity correction but more complications.

1982

Closed wedge osteotomy

Technical Concept

Greater correction from the first metatarsal base

Shortcomings

Technically imprecise, fixation problem, bone shortening

1992

Dome/Crescentic osteotomy

Technical Concept

A semi-circular cut for unrestricted correction without shortening

Shortcomings

Technically difficult and more complications

2007

Open-wedge osteotomy

Technical Concept

Can gain bone length, easy approach

Shortcomings

Requires special metal implant and bone graft

1979

Chevron osteotomy - proximal

Technical Concept

A "V" cut, good stability, less bone loss and shortening

Shortcomings

Correction limitation

Shaft Osteotomy

Provides greater bone-cut contact surface for greater stability and correction.

1918

Ludloff osteotomy

Technical Concept

Horizontal oblique cut, MPV correction by distal angulation

Shortcomings

Increase in DMAA and residual hallux valgus

1926

Scarf osteotomy

Technical Concept

Long horizontal "Z" cut, rediscovered in 1995 to reduce DMAA effect

Shortcomings

Technical difficulties in cutting and fixation

Minimally-invasive Osteotomy Procedures

Same bone-breaking concept but performed through smaller incisions.

2000

SERI, keyhole, percutaneous procedures

Technical Concept

Smaller incisions

Shortcomings

Less correction and control

Phalanx Osteotomy

Break-n-tilt of big toe.

1925

Akin osteotomy

Technical Concept

To supplement insufficient correction by metatarsal break-n-shift procedures

Shortcomings

A cosmetic endeavor without proven function benefits

3. Arthrodesis Procedures

Fusing the tarsometatarsal joint to prevent recurrence.

1930

Lapidus procedure

Technical Concept

Fusing a mobile joint to improve stability and prevent recurrence

Shortcomings

Reduced movement and function of medial column, not for the young and active

2016

Lapiplasty

Technical Concept

A new surgical jig for 3-D correction

Shortcomings

Similar to Lapidus Procedure

4. Soft Tissue Procedures

Bone realignment without osteotomy or arthrodesis.

1952

McBride procedure

Technical Concept

Mainly to help big toe look straighter without breaking bones.

Shortcomings

Underlying MPV culprit unchanged, recurrence rate high

1961

Syndesmosis (Osteodesis) Procedure

Technical Concept

Pathology-specific approach, min. surgical trauma, max. function restoration and recurrence prevention, for all bunion correction

Shortcomings

Syndesmosis formation is constant and permanent but requires 3 months of limited walking.

2010

Mini tight-rope procedure

Technical Concept

Non-bone-breaking, meant to be minimal-invasive originally

Shortcomings

Tricky technique, fracture complication, now an open procedure