Hallux valgus (bunion deformity) is a misalignment of the first metatarsophalangeal joint (MTPJ) that causes the big toe (hallux) to deviate towards the second toe. Surgical hallux valgus correction significantly improves foot geometry and hallux kinematics but does not significantly change proximal kinematics, according to research from Marquette University in Milwaukee, WI. El hallux valgus es la deformidad que con mayor frecuencia encontramos en el ante pié. Careful dissection is carried out in the loose areolar tissue plane that is naturally there, created by movement of skin and subcutaneous tissue over the capsular structures. The dorsal and plantar flaps thus created carry the dorso-medial and plantar-medial digital nerves and are kept retracted and away from instruments for rest of the procedure. The bunion prominence on medial aspect of the head of the metatarsal is excised in line with the medial aspect of the foot. The drill hole is started on the medial surface of the head at or just proximal to the center of an imaginary sphere that is the head of the metatarsal and driven in a direction that is medial to lateral and in line that is parallel to the plantar surface and the articular surface of the head of the metatarsal (see the images below). The limbs of the chevron cuts extend proximally at a 60 º angle, the plantar cut exiting the plantar cortex proximal to the sesamoid articulation. Bunions that cause severe pain and deformity of the toes and foot need surgical correction. The goal of the surgery is to correct the deformity, realign the joint and stop the pain. Bunion surgeries are outpatient procedures, but individuals take months to fully recover and have all the swelling and pain resolve, according to the University of Maryland Medical Center. Few studies, however, have evaluated the effect of exercise after hallux valgus surgery. The classic mechanism of injury is one of hyper-dorsiflexion of the first MTPJ with axial loading of the heel, while the foot is plantar flexed ( Fig 53-9 )). This combination of forces results in two primary injuries: a) a tearing of the capsular structures where they insert on the metatarsal neck; and b) a compression injury to the dorsal articular surface of the metatarsal head ( Fig 53-9 ). Clinically, this is most often seen when one player has his foot firmly planted on the playing surface while another player lands on the back of his foot, forcing the first MTPJ into hyperextension (dorsiflexion). Bilateral osteotomies are noted in the 5th metatarsalsfor correction of "bunionette" deformities. Hallux valgus cannot be adequately assessed unless weight-bearing viewsare performed in the AP and lateral positions. With experience, the radiologist can make valuable observations inboth the pre- and postoperative films in patients with hallux valgus. Kilcoyne RF, Farrar E. Injuries and deformities of the foot. The treatment of a bunion depends entirely on how uncomfortable it is. Since the pain from a bunion is always aggravated by shoe wear, the symptoms will often depend on the type and size of shoes worn. The perception of pain or discomfort that people experience however is quite varied. There are some individuals who have small bunions that are very uncomfortable. Either way, these foot problems are indicative of our modern society, fashion-obsessed culture, and sedentary lifestyles. Thus, treatment had varying results, with controversy over whether to remove the overlying bursa alone or in combination with an exostectomy of the medial head. These surgeries were considered to be beneath many surgeons, so the understanding of the pathology of Heel Spur was gradual in its development. Surgeons slowly began to recognize that bunions could develop as a result of numerous different factors, that they tended to be familial, and that they often were associated with other foot deformities. As the school of thought began to shift, the first surgical treatment to address deforming pathology was developed and presented on May 4, 1881, when J. L. Reverdin gave a report on hallux abductovalgus to the Medical Society of Genfer. Foot Ankle Int 1995;16:682-697.