The painful bunion deformity is a common and relatively disabling condition that affects individuals of all ages. Over 150 procedures have been described for the treatment of hallux valgus and the orthopaedic literature has focused predominantly on surgical management of this condition; however, successful treatment is often achieved by simple off the shelf orthotic devices and appropriate shoe wear modifications. Given the potential for surgical complications, the significant recovery period associated with bunion surgery and the occasional patient dissatisfaction with otherwise technically successful procedures, it is recommended that non-operative treatment be initiated prior to proceeding with surgery. It is not uncommon for a patient to present with an asymptomatic bunion who is actively seeking surgical correction for cosmetic concerns or because they are unable to comfortably wear fashionable shoes. While pain alone is not the only indication for surgery, it is not recommended that surgery be performed for cosmesis alone.
Bunion deformity is typically classified as mild, moderate and severe. In general, the more severe the deformity, the greater the magnitude of surgery required and the greater the recovery time. Recent research has shown that some procedures are inherently more stable than others and allow for large correction of deformity while remaining biomechanical stable.
The technique pioneered by Dr. G. James Sammarco, MD was correction of the bunion deformity with a proximal “chevron” type osteotomy and was adopted internationally. Dr. Sammarco’s technique remains one of the most frequently performed surgeries for moderate and severe hallux valgus correction.
Recent biomechanical studies have both validated the proximal chevron osteotomy, but have also show that some newer osteotomies may provide higher levels of stability while maintaining the same excellent correction. Dr. Vincent James Sammarco, MD recently published a new surgical technique for hallux valgus correction which utilizes an osteotomy of the first metatarsal which has proven extremely stable. This technique allows for earlier weight bearing and more reliable bone healing. Dr. Sammarco has been using this technique for moderate and severe bunions for over 2 years with excellent success.
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Publications by Dr. Sammarco & Dr. Sammarco on Hallux Valgus
1. SAMMARCO, G.J. and RUSSO-ALESI, F.G.: Bunion correction using proximal chevron osteotomy: a single-incision technique. Foot Ankle Int, 19: 430-7, 1998.
2. SAMMARCO, G.J.; BRAINARD, B.J.; and SAMMARCO, V.J.: Bunion correction using proximal Chevron osteotomy. Foot Ankle, 14: 8-14, 1993.
3. SAMMARCO, G.J. and CONTI, S.F.: Proximal Chevron metatarsal osteotomy: single incision technique. Foot Ankle, 14: 44-7, 1993.
4. SAMMARCO, V.J. and NICHOLS, R.: Orthotic management for disorders of the hallux. Foot Ankle Clin, 10: 191-209, 2005.
5. ACEVEDO, J.I.; SAMMARCO, V.J.; BOUCHER, H.R.; PARKS, B.G.; SCHON, L.C.; and MYERSON, M.S.: Mechanical comparison of cyclic loading in five different first metatarsal shaft osteotomies. Foot Ankle Int, 23: 711-6, 2002.
6. SAMMARCO, V.J. and ACEVEDO, J.: Stability and fixation techniques in first metatarsal osteotomies. Foot Ankle Clin, 6: 409-32, v-vi, 2001.
7. SAMMARCO, V.J. : Mau Osteotomy for Correction of Moderate and Severe Hallux Valgus Deformity. Foot Ankle Int, 28: 857-864, 2007.
8. Sammarco, VJ “Techniques in Hallux Valgus Correction: Proximal Metatarsal Osteotomy with Distal Soft Tissue Correction and Metatarsophalangeal Joint Arthrodesis” in Instructional Courses Lectures, Volume 57 pages 414-428, American Academy of Orthopaedic Surgeons 2008
9. Sammarco, VJ “Mau Osteotomy for Correction of Moderate and Severe Hallux Valgus”. Video Supplement for Instructional Course Lectures Vol 57; Editor, Duwelious, PJ; Azar, FM. American Academy of Orthopaedic Surgeons 2008 (Surgical Technique Video)
10. Sammarco, VJ “Surgical Correction of Moderate and Severe Hallux Valgus. Proximal Metatarsal Osteotomy with Distal Soft-Tissue Correction and Arthrodesis of the Metatarsal Joint” J Bone Joint Surg. AM., 89: 2520-2531. November 2007
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