Fax: (239) 692-9436
Tel: 239-430-3668Bunion (Hallux Abducto Valgus) — Expert Care from Florida's Leading Podiatric Practice
Family Foot & Leg Center is Florida's premier multi-physician podiatric surgical group, founded and led by Dr. Kevin Lam, DPM — a board-certified foot and ankle surgeon and nationally and internationally recognized lecturer on bunion surgery. Our practice is headquartered at our flagship Downtown Naples, FL location, with nine offices spanning Southwest Florida, the Gulf Coast, and Sarasota. Our team of fellowship-trained, board-certified podiatric surgeons brings sub-specialist expertise to every patient evaluation, ensuring that the right procedure is selected by the right surgeon for the right patient — every time.
One of the most rewarding procedures our surgical team performs — and one where our outcomes consistently rank among the best in the nation — is the correction of the painful bunion. A bunion, medically termed Hallux Abducto Valgus — commonly called a bunion — is far more than a cosmetic bump. It represents a true three-dimensional structural deformity of the first metatarsal that, left untreated, progressively worsens, impairs gait, and limits quality of life. Patients typically present with pain inside or around dress shoes, swelling at the base of the great toe, redness from shoe friction, and in advanced cases, the great toe overlapping or underlapping the second toe.
Whether your bunion is mild and calls for a scarless keyhole correction, or severe and demands the definitive three-plane Lapiplasty fusion, our physicians have the training, the technology, and the surgical volume to deliver exceptional results. No other practice in Southwest Florida — and few in the nation — can offer the full spectrum of bunion procedures under one roof, performed by surgeons who actively teach these techniques to colleagues nationwide.
Root Causes
- Abnormal foot mechanics — excessive pronation (flat foot)
- Genetic predisposition to ligamentous laxity
- Hypermobility of the first tarsometatarsal joint
- Neuromuscular imbalance and tendon pull
- Ill-fitting footwear (accelerates, does not cause)
- Inflammatory arthritis (rheumatoid, psoriatic)
Common Symptoms
- Painful bump on the inner border of the foot
- Deviation of the great toe toward the 2nd toe
- Redness, swelling, and warmth at the joint
- Pain aggravated by closed-toe shoes
- Corns or calluses between the 1st and 2nd toes
- Occasional bursitis over the bunion prominence
An important point: bunions are not caused by shoes. Archaeological evidence from barefoot-wearing populations confirms that Hallux Abducto Valgus results from abnormal biomechanics passed through genetics. Shoes may worsen discomfort and accelerate progression, but the underlying deformity originates in the skeletal architecture of the foot.
The Three Zones of Bunion Correction
Selecting the correct surgical procedure is not guesswork — it is a precise science grounded in radiographic measurement and biomechanical analysis. The single most important measurement is the intermetatarsal angle, which describes the angular spread between the first and second metatarsal bones on a weight-bearing X-ray. This angle directly determines the operative zone of correction:
Zone 1
Head Osteotomy
Intermetatarsal angle less than 13 degrees — mild to moderate deformity
A bone cut performed near the neck or head of the first metatarsal to shift and reposition the metatarsal head. Ideal for patients with low intermetatarsal angles, offering rapid recovery, minimal incisions, and excellent cosmetic results.
- Austin (Chevron) Bunionectomy — the gold-standard V-shaped osteotomy at the metatarsal neck
- Lam Minimally Invasive / Keyhole Bunionectomy — Dr. Lam's proprietary modification via a 5 mm incision; virtually no visible scar
- Reverdin Osteotomy — corrects articular surface angle at the metatarsal head
- Peabody Osteotomy — angulatory head procedure for plantarflexory component
Zone 2
Base Osteotomy
Intermetatarsal angle 13 to 18 degrees — moderate to severe deformity
When the intermetatarsal angle exceeds the corrective capacity of a head-level cut, a bone cut at the base of the metatarsal allows greater angular correction. The base location provides a longer lever arm for powerful realignment.
- Closing Wedge Base Osteotomy — removes a wedge of bone to narrow the intermetatarsal angle; inherently stable
- Opening Wedge Base Osteotomy — spreads the metatarsal base; may require bone graft or cage
Zone 3
Metatarsal-Cuneiform Fusion
Intermetatarsal angle greater than 16 degrees — moderate to severe or hypermobile deformity
For large intermetatarsal angles or cases complicated by hypermobility of the tarsometatarsal joint, a fusion of the first metatarsal-cuneiform joint is the most definitive correction — addressing the deformity at its root cause.
- Lapidus Procedure — the classic first metatarsal-cuneiform arthrodesis
- Lapiplasty® (3D Lapidus) — modern, precision-guided modification with titanium plating and earlier weight-bearing
Signature Procedure at Family Foot & Leg Center
Lapiplasty® — The 3D Bunion Correction
The Lapiplasty® Procedure is a modernized, instrumented evolution of the classic Lapidus first metatarsal-cuneiform joint fusion. Where a traditional head osteotomy only shifts the metatarsal in two dimensions, the Lapiplasty corrects all three planes of deformity simultaneously: the angular deviation (intermetatarsal angle), the rotational element (the toe pronation so commonly missed), and the sagittal/elevation plane. This is the same fundamental corrective principle first described by Dr. Paul Lapidus in 1934 — fusing the first metatarsal-cuneiform joint to eliminate hypermobility at the root of the problem — but executed with precision titanium cutting guides and low-profile fixation plates that allow most patients to begin weight-bearing in a boot within days rather than weeks.
Fusion Site
1st Metatarsal-Cuneiform joint — the hypermobile root of the deformity
3-Plane Correction
Corrects the intermetatarsal angle, metatarsal rotation, and elevation — not just the surface bump
Titanium Fixation
Precision cutting jigs + low-profile titanium plates for stable fusion
Earlier Weight-Bearing
Modern fixation allows many patients to walk in a boot within days
Lower Recurrence
Fusion at the root eliminates the hypermobility that causes recurrence
Lapidus Lineage
A precision modification of the proven 1934 Lapidus arthrodesis technique
Note: Not every bunion requires a Lapiplasty. The procedure is specifically indicated for moderate-to-severe intermetatarsal angles, hypermobility of the first metatarsal-cuneiform joint, or cases where prior head-level surgery has failed. Dr. Lam's individualized evaluation determines the optimal approach for each patient's anatomy and lifestyle goals.
All Bunionectomy Procedures at Family Foot & Leg Center
Our surgical team is fluent in the full spectrum of bunion surgery. Below is a detailed overview of each procedure we offer, organized by operative zone.
1
Austin (Chevron) Bunionectomy
Zone 1 · Head Osteotomy · Mild-to-Moderate Bunion Deformity
The Austin bunionectomy — also called a Chevron osteotomy — is one of the most widely performed bunion procedures in the world. A precise V-shaped (chevron) cut is made in the metatarsal head, and the distal fragment is shifted laterally to narrow the intermetatarsal angle. A small screw or pin provides fixation. Recovery is typically 4–6 weeks in a surgical shoe. The Austin is the procedure of choice for patients with mild-to-moderate bunions (intermetatarsal angle under approximately 13 degrees) who have good bone stock and an intact first metatarsal-cuneiform joint without hypermobility.
2
Lam Minimally Invasive Keyhole Bunionectomy
Zone 1 · Head Osteotomy · 5 mm Incision · Dr. Kevin Lam's Signature Technique
Developed and refined by Dr. Kevin Lam right here in Naples, Florida — and now taught to surgeons nationally and internationally — the Lam Keyhole Bunionectomy is a percutaneous modification of the metatarsal head osteotomy performed through a single 5 mm incision. Using specialized burr instrumentation under fluoroscopic guidance, Dr. Lam sculpts and repositions the metatarsal head with precision, leaving virtually no visible scar. The technique combines the proven biomechanical principles of the Austin osteotomy with the aesthetic and recovery advantages of minimally invasive surgery. It is ideal for appropriate candidates seeking an expedited return to normal footwear and activity. To learn more, visit our Scarless Bunionectomy page.
3
Reverdin & Peabody Osteotomies
Zone 1 · Articular Surface Corrections · Head-Level Procedures
The Reverdin osteotomy adds a medial closing wedge to the metatarsal head to correct an elevated Hallux Abductus Angle — the angulation of the articular surface itself. The Peabody osteotomy addresses a plantarflexory or dorsiflexory component at the metatarsal head. These procedures are often combined with an Austin osteotomy to achieve multi-plane correction when the articular surface orientation contributes to the overall deformity. Selection is based on careful radiographic analysis of the distal metatarsal articular angle and metatarsal head morphology.
4
Base Wedge Osteotomies — Opening & Closing
Zone 2 · Proximal Osteotomy · Moderate-to-Severe Bunion Deformity (intermetatarsal angle 13 to 18 degrees)
When the intermetatarsal angle exceeds the corrective capacity of a head-level osteotomy, the surgeon moves the cut to the proximal base of the first metatarsal. A closing wedge osteotomy removes a small wedge of bone from the lateral base of the metatarsal, allowing the shaft to hinge medially and narrow the intermetatarsal angle. It is inherently stable and requires minimal to no bone graft. An opening wedge osteotomy instead spreads the medial base of the metatarsal with a structural bone graft or titanium wedge-cage, achieving correction without shortening the bone — a key advantage for patients with a relatively short first metatarsal. Plate and screw fixation is used in both variants. These procedures are powerful corrections for the moderate-to-severe deformity range but, unlike the Lapidus and Lapiplasty procedures, do not address underlying hypermobility of the first metatarsal-cuneiform joint — something Dr. Lam carefully evaluates in every candidate.
5
Lapidus Arthrodesis / Lapiplasty® — First Metatarsal-Cuneiform Fusion
Zone 3 · Metatarsal-Cuneiform Fusion · Moderate-to-Severe Bunion Deformity with Hypermobility
The Lapidus procedure, first described by Dr. Paul Lapidus in 1934, is the gold-standard surgical approach for moderate-to-severe bunions associated with hypermobility of the first tarsometatarsal (metatarsal-cuneiform) joint. By fusing this joint, the surgeon permanently eliminates the pathological motion that drives the deformity — addressing the root cause rather than the downstream consequence. The result is a mechanically stable, corrected first ray that resists recurrence.
The Lapiplasty® is the modern, Treace Medical-engineered iteration of this classic technique. It uses precision titanium surgical cutting guides to correct the bunion in all three spatial planes — frontal, transverse, and sagittal — followed by application of low-profile titanium locking plates across the metatarsal-cuneiform joint. This 3D reproducibility, combined with the structural stability of the fixation construct, allows many patients to bear weight in a boot within a few days of surgery, a significant improvement over the traditional 6–8 weeks of non-weight-bearing associated with older Lapidus fixation methods.
Dr. Kevin Lam and the Family Foot & Leg Center team are certified Lapiplasty surgeons with extensive experience in this procedure and lecture on its technique, indications, and outcomes at national and international podiatric surgical conferences.
Conservative (Non-Surgical) Treatment First
Before surgery is ever discussed, Dr. Lam's approach follows a comprehensive conservative management protocol. Many patients with mild-to-moderate bunions achieve significant pain relief without going to the operating room.
- ✦Shoe Modification: Wider toe-box shoes, soft leather uppers, and rocker-sole modifications reduce bunion pressure.
- ✦Custom Functional Orthotics: Prescription foot orthoses control abnormal pronation, reducing the deforming forces on the first metatarsal and slowing progression.
- ✦Padding & Splinting: Silicone spacers and bunion pads reduce soft-tissue irritation; night splints may slow toe drift in early deformities.
- ✦Anti-Inflammatory Therapy: Oral anti-inflammatory medications or corticosteroid injections address acute bursitis and joint inflammation.
- ✦Physical Therapy: Strengthening intrinsic foot musculature, joint mobilization, and gait retraining at our on-site physical therapy program.
When conservative measures fail to provide adequate relief after a reasonable trial period, or when the deformity is severe and progressive, surgical correction is recommended.
Watch: Our Bunion Surgery Video Library
Our surgeons are committed to patient education. Dr. Lam and the Family Foot & Leg Center team have produced an extensive library of bunion surgery videos — covering procedure explanations, patient testimonials, surgical technique overviews, and post-operative guidance — available free on our YouTube channel. This playlist is one of the most comprehensive physician-authored bunion video resources available anywhere online.
Florida's Most Experienced Bunion Surgical Team
What separates Family Foot & Leg Center from any single-physician podiatry office is the depth and breadth of our team. Our practice brings together multiple board-certified, fellowship-trained podiatric surgeons — each with sub-specialist expertise — under a unified clinical philosophy: choose the right procedure for the right patient, execute it with precision, and educate the next generation of surgeons along the way.
Multi-Physician Practice
A full team of board-certified podiatric surgeons — not a single-doctor office. When you see any physician at Family Foot and Leg Center, you have the collective experience of the entire practice behind your care plan.
Fellowship-Trained Surgeons
Our physicians hold post-residency fellowship training in foot and ankle reconstructive surgery — the highest level of surgical specialization in podiatric medicine. We also host our own fellowship program, training the next generation right here in Florida.
National & International Educators
Dr. Kevin Lam and our senior surgeons are invited lecturers at national podiatric surgical conferences and international symposia. We don't just perform these procedures — we teach them to surgeons across the country and around the world.
9 Florida Locations
From our Naples, FL headquarters to Fort Myers, Cape Coral, Estero, Port Charlotte, Sarasota, and beyond — our network means expert bunion care is never far from where you live or work.
Florida's Most Awarded Practice
Family Foot & Leg Center has received more regional and national recognition than any other podiatric group in SWFL. Our awards reflect consistently superior patient outcomes, not just years in practice.
Full Surgical Spectrum
From the Lam 5 mm keyhole procedure to complex Lapiplasty 3D fusion, every bunion correction in the surgical literature is available at Family Foot and Leg Center — selected by your surgeon based on your anatomy, not by what the practice happens to offer.
