Surgical Correction of Juvenile Bunion

Surgical Correction of Juvenile Bunion

B. David Horn


  • Metatarsus primus varus resulting in increased intermetatarsal (IM) angle2, 3

  • Obliquity of the medial cuneiform-first metatarsal joint2, 3

  • Medial prominence of the first metatarsal head

  • Valgus angulation through the first metatarsophalangeal joint2, 3

  • Minimal or no deformity through the first interphalangeal joint

  • Lateral translation of sesamoids

  • Plantar-lateral positioning of the abductor hallucis with unopposed pull of the adductor hallucis muscle

  • Lateral subluxation of the extensor hallucis longus and flexor hallucis longus tendons

  • Pronation (internal rotation) of the first toe

  • Differs from an adult bunion

    • Physis of the first metatarsal and proximal phalanx are located proximally (this limits ability to perform proximal osteotomies in skeletally immature patients).

    • The first metatarsophalangeal joint does not have osteoarthrosis.

    • The medial eminence is less prominent in adolescent bunions than in adult bunions.


  • Multiple theories exist; it is difficult to differentiate primary findings from secondary ones.2, 3, 6

  • Extrinsic and intrinsic factors contribute to formation of adolescent bunions.

  • Intrinsic

    • Metatarsus primus varus

    • Obliquity of the medial cuneiform-first metatarsal joint

    • Long first metatarsal

    • Ligamentous laxity

    • Heel cord contracture causes foot pronation, which in turn places a valgus force on the hallux while walking

  • Extrinsic

    • Shoe wear, particularly those with a narrow toe and elevated heel


  • Natural history is believed to be favorable. Most patients with adolescent bunions can be treated nonoperatively.2, 5


  • Patients typically present in late childhood or adolescence.2, 3

  • Complaints about appearance of foot

  • Complaints of pain over the medial exostosis or about the first metatarsophalangeal joint

  • Pain is exacerbated by shoe wear.

  • Complaints about finding shoes that are comfortable

  • Physical examination2, 3

    • Areas of tenderness: first metatarsophalangeal joint, medial prominence

    • Alignment when standing and walking

    • Mobility of first metatarsophalangeal joint

    • Skin condition: the clinician should search for calluses, areas of irritation

    • Foot and ankle range of motion

  • Careful neurologic examination

Jul 22, 2016 | Posted by in ORTHOPEDIC | Comments Off on Surgical Correction of Juvenile Bunion
Premium Wordpress Themes by UFO Themes