A 2-mm incision is made using a medial approach over the proximal phalanx metaphysis. Detachment of the periosteum is performed with a small elevator dorsally and plantarly. The osteotomy is performed with the cutting burr under fluoroscopy control, preserving the lateral cortex of the phalanx. A pilot hole is made in the medial cortex and then sweep the burr plantar and dorsally without cutting the lateral cortex. Closed reduction is performed and checked by interposing the small elevator. No fixation is used. The great toe is bandaged in a forced varus position to maintain the correction. There are only a small number of prospective randomized trials comparing different surgical procedures or investigating conservative treatment ( Table 2 ). The whole published literature contains only four publications ( 23 , 29 – 31 ) in which operative techniques were compared, none of which reached any clear conclusions. This shows the limits of current scientific knowledge, particularly when it comes to detailed questions of surgery. Whether, for example, the adductor tendon must be divided or the intermetatarsal angle corrected has to be decided according to the patient’s specific deformity. These techniques can hardly be randomized without taking account of the exact deformity. In the US, more women seem to suffer from bunion than their male counterpart. Documentations show that more women undergo forefoot operations for the common ailments which are bunion, neuroma, and hammertoe. This may be due to the fact that women wear more restricting footwear than men. Commonly, women who wears shoes which are too tight will often get bunion pains and irritations. There are some individuals who have small bunions that are very uncomfortable. This limits their ability to wear shoes comfortably. On the other hand, some individuals may have quite significant deformities that are annoying but do not limit their activities in anyway. As you can now see, " hallux valgus " refers to the outward turning of the bone of the joint of the great toe, or as we say, the big toe, in an abnormal manner. This is the hallux valgus deformity. This outward turning of the bone of the joint, also known as the first metatarsophalangeal joint, is usually combined with soft tissue enlargement under the skin that shows up as a bump on the outside of the foot. This bump is what we call a bunion. In the medical profession today, the term " hallux valgus " is used to denote the condition of having a bunion. There are several surgical procedures that can be done to correct the deformity if conservative care fails. Procedures done closest to the joint are usually for smaller deformities and have a faster recovery than procedures done at the base of the bone which require staying completely off of the foot for 6-8 weeks. You should not use a code in case it contains any terms or procedures that the podiatrist did not do, although it otherwise faultlessly describes the procedure, experts warn. The surgeon should do everything described within the CPT code in order for a coder to be capable to select it. A bunion, or hallux valgus , is a deformity of the big toe joint. This type of pathology is usually manifested as a “bump” on the inside of the foot just behind the big toe. The bump can be very small or reasonably large; the size of which is not necessarily proportional to the amount of pain one can experience. Along with this bony bump there can be an associated bursitis which is a “cushion” that the body originally creates to protect an area from pressure or friction, but after a while this cushion can also become inflamed and painful. I am often told that bunions are a common complaint in podiatric practice, but I am not sure that this is actually true! Hallux valgus on the other hand is incredibly common, the associated soft tissue swelling, or bunion, is much less common thankfully. Is this possibly because footwear is generally better designed, being softer and wider, accommodating the medial eminence? Also there are fewer constraints from society on what is an acceptable style of footwear for every day activity. The truth is that we are a little lazy and call all bumps around the big toe “bunions”. Singh et al., have described a modified step cut osteotomy for the shortened first metatarsal with metatarsalgia. 14 They had shown that adequate relief of metatarsalgia was achieved in patients who had 10mm lengthening. There is no report in the literature of patients developing arthritis of the first MTPJ following lengthening of the short first metatarsal. Our patient developed arthritis of the first MTPJ after a lengthening Scarf procedure two years later. In our patient there was no evidence of AVN of the first metatarsal head. Another explanation for the early development of arthritis could be the increased pressure of the first MTPJ following the lengthening. Hammer toes are also a common cause of foot pain. In this condition the toes protrude and curl downward into a claw like position. Hammer toes are contracted at the middle joint in the toe (PIP Joint). When ligaments and tendons tighten the joints in the toe are pulled downward. Hammer toes do not occur in the big toe. Bunions are generally not inherited, but certain foot types are that may lead to hallux valgus at some point. Ligamentous laxity, a hypermobile foot, a foot that pronates (flattens) excessively, or arthritides (such as rheumatoid or gout) are all conditions that may predispose a person to develop hallux valgus.