The Chevron osteotomy is a widely performed surgical procedure used to correct mild to moderate cases of hallux valgus, commonly known as bunions.
Understanding Hallux Valgus
Hallux valgus is a progressive deformity characterized by a lateral deviation of the big toe (hallux) and a medial deviation of the first metatarsal bone. This misalignment forms a prominent bony bump at the base of the big toe, leading to pain, discomfort, and difficulty with footwear. Bunions can arise from genetic predisposition, wearing narrow shoes, biomechanical abnormalities, or inflammatory diseases. Over time, untreated bunions can cause calluses, bursitis, and osteoarthritis within the first metatarsophalangeal (MTP) joint.
Conservative therapies—such as orthotics, shoe modification, padding, and anti-inflammatory medications—aim to alleviate discomfort but cannot correct the deformity. When non-surgical methods fail, surgical correction becomes necessary. Among the several surgical options, the Chevron osteotomy (also known as the Austin bunionectomy) remains one of the most common and effective for mild to moderate deformities.
What is a Chevron Osteotomy?
The Chevron osteotomy, first introduced in 1968, involves creating a V-shaped (chevron) cut at the distal end of the first metatarsal bone—the long bone leading to the big toe. The apex of the “V” typically points toward the toes, and the arms extend into the bone shaft at approximately a 60-degree angle. The surgeon then shifts the head of the metatarsal laterally (toward the outer side of the foot) to realign the big toe into a more anatomically correct position. This realignment corrects the abnormal angle between the first and second metatarsals, thereby straightening the toe.
After the cut, surgeons often secure the repositioned bone fragment using small screws or pins—a method known as internal fixation—to hold the bone stable during healing. In some older versions, fixation was not always used, but modern techniques usually include hardware to reduce recurrence risk and allow early mobility
Indications and Patient Selection
The Chevron osteotomy is suitable for individuals with mild to moderate hallux valgus deformities. The procedure is most effective for younger patients or those without significant joint arthritis. It works best when the first MTP joint remains congruent—that is, the joint surfaces still align well despite the bunion angle. The surgery is contraindicated in severe cases of bunion deformity, marked arthritis, or if the joint is incongruent with tight adductor muscles or restrictive ligaments.
Patients typically undergo surgery after conservative treatments fail to relieve symptoms. It is not advisable if the bunion is painless or purely cosmetic. Surgeons also avoid performing it in patients with poor blood flow, active infections, or uncontrolled diabetes because of higher complication risks.
The Surgical Procedure
The procedure is commonly performed on an outpatient basis under local, regional, or general anesthesia. A small incision is made on the medial side of the big toe joint. The surgeon exposes the head of the first metatarsal, trims any bony prominence causing the lump (exostectomy), and performs the Chevron cut. Once the distal fragment is shifted laterally, the toe is realigned. Small screws, wires, or sometimes bioabsorbable pins are inserted for fixation. Occasionally, soft-tissue adjustments around the joint accompany the osteotomy—especially release of the tight lateral capsule or tightening of the medial structures—to achieve optimal balance.
Some surgeons combine the Chevron osteotomy with other minor procedures, such as the Akin osteotomy, which involves a small wedge cut in the proximal phalanx of the great toe to fine-tune the alignment. This combined Chevron-Akin approach enhances correction and stability, particularly in patients with greater angular deformities
Modern Techniques and Innovations
Advancements in surgical instrumentation have made modern Chevron osteotomies less invasive. Minimally invasive or percutaneous techniques now allow surgery through smaller incisions, using specialized burrs under fluoroscopic guidance. This approach minimizes soft-tissue trauma, reduces pain and swelling, and leads to faster recovery. Internal fixation has also evolved, with surgeons employing low-profile screws and even bioabsorbable implants to maintain alignment during healing.
Benefits of the Chevron Osteotomy
The Chevron osteotomy provides multiple benefits for appropriate patients. The primary goals are pain relief and improved toe alignment. By restoring the normal mechanics of the first MTP joint, it allows better weight distribution during walking. The procedure also corrects cosmetic deformity, making footwear more comfortable. Studies show that most patients experience significant improvement in their intermetatarsal and hallux valgus angles, providing long-lasting results with high satisfaction rates.
Since it is a relatively stable osteotomy, early mobilization is often encouraged, reducing stiffness and promoting bone healing. The shape of the V-cut offers natural mechanical stability, and internal fixation further enhances this advantage. Compared to more proximal or complex osteotomies, the Chevron method carries less risk of metatarsal shortening, transfer metatarsalgia, or nonunion.
Risks and Complications
Like any surgery, the Chevron osteotomy carries some risks. Common complications include postoperative swelling, stiffness, recurrence of the deformity, or overcorrection (hallux varus). Occasionally, hardware irritation can occur, necessitating screw removal. There is also a risk of delayed union if fixation is inadequate or if the patient resumes weight-bearing too early. Nerve injury around the incision site can cause temporary numbness, and in rare cases, infection or wound healing problems may occur.
Failure to adhere to postoperative protocols—such as using supportive footwear or avoiding premature activity—can jeopardize the surgical outcome. The skill of the surgeon and the suitability of the patient’s anatomy also play major roles in success rates
Postoperative Care and Recovery
Following surgery, the foot is typically bandaged and protected with a specialized postoperative shoe that allows limited weight-bearing. Elevation and ice minimize swelling during the initial recovery phase. Patients are usually advised to avoid full-foot loading for the first few weeks. Sutures are removed after about two weeks, and light walking in the surgical shoe follows. Physical therapy may begin after four to six weeks to improve joint mobility and strength.
Full recovery—including return to normal shoes and activities—typically takes about two to three months, though some swelling can persist longer. Radiographic evaluation ensures proper healing and correction. Most patients report reduced pain, improved foot function, and satisfaction with cosmetic results.
Comparison with Other Osteotomies
Other bunion surgeries include the Scarf, Akin, proximal Chevron, and Lapidus osteotomies. Compared with these, the Chevron approach is simpler and less invasive, with a faster recovery for mild deformities. However, it offers limited correction potential for severe hallux valgus, where more extensive bone rearrangement may be necessary. Studies comparing the Chevron to distal oblique osteotomies have found comparable radiographic and patient satisfaction outcomes, confirming that the Chevron remains a reliable standard for mild to moderate cases.
The Chevron osteotomy represents a time-tested and refined surgical technique for the management of mild to moderate hallux valgus deformities. It effectively straightens the big toe, relieves pain, and improves foot function with minimal downtime and low complication rates. While not suitable for every patient, especially those with severe deformities or joint arthritis, it remains the gold standard procedure for many surgeons worldwide. As technology advances, minimally invasive Chevron techniques promise even better outcomes, making this operation both efficient and patient-friendly