A bunion (medical term: hallux valgus) is a deformity of the big toe joint. The first metatarsal bone drifts inward (toward the other foot) and the big toe (hallux) drifts outward, towards the second toe. This creates that characteristic bump on the inside of the foot near the big toe. The bump is the head of the metatarsal bone jutting out. Over time, the big toe can even overlap the second toe. Bunions often come with joint pain, swelling, and difficulty fitting into shoes as the deformity worsens.

Causes: Bunions are multi-factorial. Genetics play a role – if your parents had bunions, you may inherit a foot shape prone to them (e.g., long first metatarsal, flat feet, or ligamentous laxity). Footwear is a notorious contributor: tight, pointed-toe shoes and high heels that crowd the toes can accelerate bunion formation (that’s why bunions are more common in women historically, due to fashionable footwear). Mechanical factors like overpronation can put excess pressure on the big toe joint. Arthritis can also cause bunion-like deformities. Occupations or activities that stress the forefoot (ballet dancers, for example) can develop bunions, too.

Once a bunion starts, it tends to progress – the alignment worsens over the years. Early on, you might see a slight bump, maybe some redness after wearing snug shoes. Later, pain might occur even in comfortable shoes. The big toe joint (the MTP joint) can become arthritic due to misalignment.

Conservative care (shoe modifications, pads, splints, orthotics) can alleviate symptoms and slow progression, but it won’t reverse the bunion. Only surgery can correct the bone alignment. That said, not every bunion needs surgery – if it’s mild and not painful, wider shoes might be all you need. But if you’re in pain or the deformity is limiting your life, it’s worth considering surgical correction.

Traditionally, bunion surgery (known as a bunionectomy with osteotomy) involved a sizable incision over the big toe joint, cutting the bone, shifting it, and fixing it with screws or pins, then a long healing period (6-8 weeks in a boot, often). While very effective in correcting the bunion, the recovery and scarring were downsides. Now, minimally invasive bunion surgery (MIS bunion surgery) is available and has transformed the experience.

• Instead of a 2-3 inch incision, we use a few tiny incisions (around 2-5 mm).
• Specialized instruments and sometimes X-ray guidance allow us to perform the same bone corrections through these keyholes.
• Less soft tissue disruption means less pain, swelling, and scar tissue.
• Recovery is faster, and often weight-bearing is allowed sooner (sometimes immediately in a stiff postoperative shoe).
• Cosmetically, the scars are minimal, and the foot often looks near-normal, even a few weeks post-op, aside from some swelling.

Our approach at Dr. Patish’s clinic is often the MIS Chevron or exostectomy and/or Akin osteotomies (sometimes called the MICA procedure). Those are technical names: Chevron osteotomy means we cut the first metatarsal in a V-shape and shift it, and Akin means we also remove a small wedge of bone in the big toe to straighten it. In MIS, we do those cuts percutaneously (through the skin) and fix the bones usually with tiny screws, all via small incisions.

• Preoperative Planning: We’ll order X-rays of your foot while standing. This allows us to measure the angles and severity of your bunion. We plan how much correction is needed. In moderate bunions, a double-cut (Chevron + Akin) is common; in very mild, maybe only one cut; in severe, sometimes more complex cuts or additional procedures like tightening a ligament might be needed. All can be done minimally invasively in most cases. We’ll discuss the plan with you so you know what to expect.
• Anesthesia: Typically, we use local anesthesia with mild oral sedation if desired. That means you won’t feel anything in your foot (it will be numbed with an ankle block), and you will receive a preoperative prescription for light anxiety medication. Vast majority of patient opt out of oral sedation. 
• Tiny Incisions: We create 2-3 very small incisions around the bunion area. One by the big toe joint for the metatarsal cut, one along the toe for the Akin cut, perhaps one on the side for instrumentation. These incisions are on the order of a few millimeters – just enough to introduce our burrs or instruments. The beauty is, we’re not making a big cut and peeling back tissue, so the joint capsule and blood supply remain much more intact.
• Bone Corrections: Using specialized low-speed high-burrs, we perform the osteotomies (bone cuts) through the tiny openings. We use a fluoroscopy (live X-ray) machine frequently to ensure accuracy (so we can see the bone alignment on a screen as we work). The Chevron cut on the 1st metatarsal allows us to shift the metatarsal head back into proper alignment (towards the second toe). We typically secure that with one or two small screws (these are buried in the bone and usually stay in forever; they’re not noticeable). Then the Akin cut on the big toe bone corrects any inward tilt of the toe – a small wedge is removed and the bone gently compressed to straighten the toe, often fixed with a tiny screw or sometimes just left to heal if stable. MIS screws are very small and can often be inserted through stab incisions or percutaneously. If needed, we might also smooth the bunion bump (the exostectomy) with the burr – but interestingly, once the bones are realigned, that “bump” naturally goes away largely, since it was the protruding bone.
• Soft Tissue Adjustments: Through small incisions or percutaneous techniques, we can also release tight soft tissues or tighten loose ones as needed. Many bunions have a tight lateral capsule (outside of big toe) and loose medial capsule – often correcting bones fixes a lot of this, but MIS techniques also allow capsule work if needed. We keep this minimal to preserve stability.
• Closure and Dressing: Because incisions are tiny, sometimes a single stitch or even just tape closes them. The foot is then wrapped in a specialized compression dressing that also holds the toe in the corrected position. We may use a postoperative shoe (a stiff flat sandal) or a boot, depending on how stable the fixation is and the surgeon’s preference for your case.

• Less Pain: Studies and patient reports find post-op pain is significantly less with MIS bunion surgery compared to traditional. Many of our patients manage with just oral analgesics (some even just Tylenol/ibuprofen after a couple of days).
• Faster Ambulation: With many MIS bunion surgeries, you can bear weight on the heel or outer foot immediately in a protective shoe. Some techniques even allow full weight on the foot in a stiff shoe right after surgery. Typically, you won’t be completely immobilized unless there’s a specific reason. Early motion is good – we often encourage moving the big toe gently after a couple of weeks (once initial healing begins) to prevent stiffness.
• Minimal Scarring: Instead of a long scar, you have a few small marks that fade significantly over time. This also lowers infection risk and avoids the issues of scar tenderness. You’ll feel more confident wearing sandals later with no obvious surgical scar glaring out.
• Quicker Recovery: While bone healing still takes around 6-8 weeks to fully consolidate (so you have to avoid high-impact until then), patients often are in a regular shoe by 4-6 weeks, sometimes sooner. Contrast that with traditional approaches that might keep you in a boot for 6 weeks and then stiff shoes. Many MIS patients can return to many activities (driving, desk work) within 1-2 weeks, and more active jobs by around 6-8 weeks. Overall, getting back to normal life is expedited.
• High Success Rate: MIS bunion techniques, when done by skilled surgeons like Dr. Patish, have comparable if not improved outcomes in terms of bunion correction angles and patient satisfaction. The bunion correction is the same internal maneuver – we’re just approaching it differently. So you can expect a well-aligned, straight big toe after healing. And by preserving more soft tissue, some believe it reduces the chances of postoperative stiffness or joint issues.

• First Few Days: Rest with foot elevated to minimize swelling. Apply ice (around the ankle area or behind the knee, not directly on incisions) as advised. You’ll have a bulky dressing – keep it dry. Some throbbing or aching is normal; take pain meds as prescribed proactively at first. Wiggle your other toes to keep circulation. You can gently heel-weight-bear with crutches or walker as instructed (if allowed full weight in shoe, follow doc’s instructions).
  • 1st Week Check: We’ll see you within 2-3 days. We might change the dressing and check incisions. Sometimes stitches (if any) are removed around 3 weeks. We’ll likely give you a smaller dressing or a bunion splint to maintain toe position.
  • Weight-bearing: Most MIS bunion patients are allowed to bear weight on the heel/outer foot immediately in a surgical shoe. By 2 weeks, often more flat-foot weight-bearing is okay in the shoe. We still advise minimal unnecessary walking initially – let pain be your guide too. At around 4-6 weeks, if X-rays show good healing, we transition you to a wide, supportive sneaker. You then start increasing activities.
  • Physical Therapy: Depending on stiffness, we may prescribe some PT exercises to regain motion of the big toe. This might include manually mobilizing the toe joint, marble pickups, towel curls, etc. Many MIS patients have great motion because we didn’t open the joint fully, but if you were stiff before (arthritic bunion), PT helps.
  • Return to Normal Footwear: Typically, around 6-8 weeks, you can consider regular shoes. We advise a comfortable sneaker or low-heeled shoe initially. Women often ask about heels – we say wait around 2-3 months before wearing a low heel, and longer for higher heels, since it puts pressure on the front foot. And maybe avoid those narrow-pointed ones that caused the bunion in the first place! (We’ll help you find more foot-friendly, stylish options if you want suggestions.)
  • Long Term: You’ll enjoy a foot where the big toe is straighter, the painful bump is gone, and you can fit into shoes normally. Bunions, once corrected, generally do not come back if the surgery addressed the root cause and you follow post-op guidance (though in very young patients or hypermobile folks, recurrence years down the line is possible, but we take steps to minimize that). Using custom orthotics or wearing sensible shoes can help maintain the correction over time.

  Patients often tell us after MIS bunion surgery, “Why didn’t I do this sooner?” They’re thrilled to ditch their old bunion pads and giant shoes. Shopping for footwear becomes fun again. Activities like dancing, hiking, or just walking around the block are no longer marred by bunion pain.

Life’s too short to live with foot pain or to avoid activities because of a bunion. If conservative measures haven’t cut it and you find yourself limited, minimally invasive surgery could be a fantastic solution. Dr. Patish has the expertise in these modern techniques, marrying the science of foot biomechanics with the artistry of surgery through tiny incisions. He will ensure you’re a good candidate (MIS works for the majority of bunions, though extremely severe deformities or those with big arthritis might need different approaches – but we’ll guide you honestly).

We also provide a caring touch: we know surgery can be daunting, so we’ll hold your hand (metaphorically, and literally if needed!) through the process. All your questions will be answered, from “Will it hurt?” to “Can I run again?” You’ll get personalized attention because every bunion and patient is a bit different.

And don’t worry, we won’t judge your shoe collection – but we might gently suggest some better choices going forward.

Ready to put your best foot forward (straightened and pain-free)?

Schedule a consultation via phone or text. We’ll examine your bunion, take X-rays, and discuss if minimally invasive surgery is right for you. We can even show you before-and-after X-rays of past patients so you see the transformation. There’s no obligation – just information and an honest recommendation. If you choose surgery, know that you’ll be in skilled hands that prioritize both outcome and your experience. Don’t let fear of old-fashioned surgery keep you from the relief you deserve – the times have changed, and bunion treatment has too. Take the first step towards a more comfortable future and contact us. Your feet will thank you!