The Chevron-Akin procedure is a surgery used to correct a common foot problem called Hallux Valgus, or bunions. This condition causes the big toe to bend towards the second toe, creating a bump on the side of the foot. The procedure involves two main parts: one to straighten the first bone of the big toe (called the first metatarsal), and the other to correct the alignment of the toe itself. This is done through small incisions, making it less invasive than traditional surgeries.
How Common It Is and Who Gets It? (Epidemiology)
Bunions are more common in women than men, often linked to wearing narrow-toed, high-heeled shoes. The condition is often hereditary, and those with a family history of foot deformities are at higher risk. Bunions commonly develop in individuals in their 30s to 60s, and they can worsen with age or improper footwear.
Why It Happens – Causes (Etiology and Pathophysiology)
Hallux valgus (bunion) occurs when the first metatarsal bone in the foot shifts outward and the big toe moves inward. Causes include:
- Genetic predisposition to abnormal foot structure.
- Wearing tight or high-heeled shoes that force the toes into unnatural positions.
- Arthritis or other inflammatory conditions affecting the toe joint.
How the Body Part Normally Works? (Relevant Anatomy)
The first metatarsophalangeal joint (MTP joint) connects the first metatarsal (foot bone) and the proximal phalanx of the big toe. This joint allows for movement necessary for walking, running, and pushing off the ground. In bunions, the alignment of this joint is disrupted, leading to pain, stiffness, and difficulty in movement.
What You Might Feel – Symptoms (Clinical Presentation)
Symptoms of a bunion include:
- Pain at the base of the big toe, worsened by pressure from shoes.
- Bony bump at the base of the big toe joint.
- Limited range of motion in the big toe.
- Swelling or redness at the joint.
- Difficulty finding shoes that fit properly due to the deformity.
- The big toe turning inward and overlapping the second toe, causing corns or calluses.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis is typically confirmed through:
- Physical examination to observe the alignment and structure of the foot.
- X-rays to assess the extent of misalignment and the angle of the big toe. This also helps identify any arthritis or bone spurs in the joint.
Classification
Bunions are generally classified based on severity:
- Mild bunion: Slight misalignment with minimal symptoms.
- Moderate bunion: Noticeable deformity, causing discomfort and difficulty with movement.
- Severe bunion: Significant misalignment with restricted toe movement and pain, requiring surgical intervention.
Other Problems That Can Feel Similar (Differential Diagnosis)
Other conditions that might mimic bunions include:
- Arthritis in the MTP joint.
- Gout or pseudogout, causing inflammation in the big toe joint.
- Tendonitis or tendinopathy in the foot.
Treatment Options
Non-Surgical Care
- Wearing wide-toed shoes to alleviate pressure on the bunion.
- Padding or spacers to reduce discomfort and separate the big toe from the second toe.
- Orthotics to improve foot alignment and distribute pressure more evenly.
- Physical therapy to strengthen foot muscles and improve flexibility.
Surgical Care
- Chevron-Akin Bunionectomy, involving realignment of the first metatarsal and correction of the toe with two osteotomies: the Chevron osteotomy (V-shaped cut) and the Akin osteotomy (small bone wedge removal).
Recovery and What to Expect After Treatment
Recovery typically involves:
- Non-weight bearing for 2 to 6 weeks to allow the bones to heal.
- Physical therapy after the initial healing phase to regain strength and mobility.
- Pain management with medications and elevation to reduce swelling.
- Full recovery usually takes 6 to 8 weeks, but it may take longer to regain full motion.
Possible Risks or Side Effects (Complications)
Possible complications include:
- Infection at the surgical site.
- Recurrence of the bunion if post-operative care is not followed properly.
- Nerve damage resulting in numbness or tingling.
- Stiffness or reduced range of motion in the big toe joint.
- Delayed healing or non-union of bones.
Long-Term Outlook (Prognosis)
The Chevron-Akin procedure has a high success rate for pain relief and functional improvement, with most patients returning to normal activities within 3 to 6 months. However, recurrence of the bunion or joint stiffness can occasionally occur.
Out-of-Pocket Costs
Medicare
CPT Code 28296 – Chevron Osteotomy: $200.67
CPT Code 28298 – Akin Osteotomy: $474.55
Medicare Part B typically covers 80% of the approved cost for these procedures once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover the remaining 20%, reducing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work in coordination with Medicare to fill the coverage gap.
If you have Secondary Insurance such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining balance, including coinsurance or small deductibles, which generally range from $100 to $300 depending on your plan and provider network.
Workers’ Compensation
If your Chevron osteotomy or Akin osteotomy is required due to a work-related injury, Workers’ Compensation will cover all treatment costs, including surgery and rehabilitation. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.
No-Fault Insurance
If your bunion surgery is related to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and follow-up care. The only possible out-of-pocket cost may be a small deductible or co-payment depending on your policy.
Example
Olivia Parker required Chevron osteotomy (CPT 28296) to correct her bunion deformity and Akin osteotomy (CPT 28298) for toe realignment. The estimated Medicare out-of-pocket cost for the Chevron osteotomy was $200.67, and $474.55 for the Akin osteotomy. Since Olivia had supplemental insurance through Blue Cross Blue Shield, both procedures were fully covered, leaving her with no out-of-pocket expenses.
Frequently Asked Questions (FAQ)
Q. What is a Chevron and Akin Bunionectomy?
A. It is a surgical procedure that involves correcting a bunion by realigning the bones of the big toe using two specific osteotomies: the Chevron osteotomy and the Akin osteotomy.
Q. What does the Chevron osteotomy involve?
A. The Chevron osteotomy involves making a V-shaped cut in the first metatarsal bone to shift the head of the bone and correct the bunion.
Q. What does the Akin osteotomy involve?
A. The Akin osteotomy involves making a small cut in the base of the big toe’s proximal phalanx to straighten the toe further.
Q. Why might both Chevron and Akin osteotomies be performed together?
A. They are often performed together to provide a more comprehensive correction of both the bunion and any associated deformities of the big toe.
Q. What kind of anesthesia is used for a Chevron and Akin Bunionectomy?
A. The procedure is typically performed under regional anesthesia, often with sedation.
Q. How long does the Chevron and Akin Bunionectomy take?
A. The surgery generally takes less than an hour to complete.
Q. Is hardware used in a Chevron and Akin Bunionectomy?
A. Yes, small screws or other fixation devices are typically used to hold the bone in place as it heals.
Q. What can patients expect immediately after surgery?
A. Patients may experience swelling and discomfort, which are managed with pain medication and elevation of the foot.
Q. When can patients begin walking after a Chevron and Akin Bunionectomy?
A. Most patients are allowed to walk in a special postoperative shoe on the same day of surgery.
Q. How long does it take to fully recover from a Chevron and Akin Bunionectomy?
A. Complete recovery typically takes about six to eight weeks, but swelling may persist longer.
Q. When can regular shoes be worn again?
A. Most patients can transition to regular footwear around six to eight weeks postoperatively.
Q. Are there risks or complications associated with this procedure?
A. Possible complications include infection, delayed healing, recurrence of the deformity, or stiffness in the big toe.
Q. What is the success rate of the Chevron and Akin Bunionectomy?
A. The procedure has a high success rate in relieving pain and improving alignment and function of the big toe.
Summary and Takeaway
The Chevron-Akin procedure is a minimally invasive option for bunion correction that offers a quicker recovery and less pain compared to traditional bunion surgeries. This method effectively corrects the deformity while preserving toe motion and allowing patients to return to their normal activities.
Clinical Insight & Recent Findings
A recent study looked at how the minimally invasive Chevron-Akin (MICA) procedure for bunions affects foot width. In 28 patients, the surgery significantly reduced both the bony and soft tissue width of the forefoot—by about 3.7 mm (4%) and 2.5 mm (2%), respectively.
These changes were linked to improvements in the hallux valgus and intermetatarsal angles, meaning the toe and bone alignment corrections directly influenced narrowing of the foot. While the reduction in width was modest compared to more invasive surgeries, it still provides meaningful improvement without large scars or extensive recovery.
Patients considering bunion surgery can be counseled that MICA reliably narrows the foot, improves alignment, and allows for earlier return to regular shoes. (“Study on how the Chevron-Akin bunion surgery changes foot width – see PubMed”)
Who Performs This Treatment? (Specialists and Team Involved)
The Chevron-Akin Bunionectomy is typically performed by orthopedic surgeons specializing in foot and ankle surgery. A multidisciplinary team including podiatrists and physical therapists may assist with post-operative care and rehabilitation.
When to See a Specialist?
If you experience pain, difficulty walking, or problems with shoe fitting due to a bunion, it’s important to consult with an orthopedic surgeon to determine whether surgical intervention like the Chevron-Akin procedure is appropriate.
When to Go to the Emergency Room?
Seek emergency care if:
- Severe pain occurs at the surgical site.
- Signs of infection, such as fever, redness, or swelling, develop.
- Inability to move the toe or bear weight on the foot after surgery.
What Recovery Really Looks Like?
After surgery, patients need to follow non-weight bearing protocols for 2 to 6 weeks and gradually resume physical activity. Full recovery typically takes 3 to 6 months, but swelling may persist for a longer period.
What Happens If You Ignore It?
Ignoring a bunion can lead to increased pain, deformity progression, and difficulty walking, which may severely affect quality of life. Over time, the condition may worsen, making conservative treatments less effective.
How to Prevent It?
Prevention includes:
- Avoiding narrow-toed shoes that compress the toes.
- Wearing properly fitting footwear to avoid undue pressure on the big toe joint.
- Managing flat feet or other structural issues early on with orthotics.
Nutrition and Bone or Joint Health
Maintaining healthy calcium, vitamin D, and protein intake supports bone health and aids in the healing process post-surgery.
Activity and Lifestyle Modifications
After the procedure, avoid high-impact activities and follow your surgeon’s guidelines for gradual reintroduction to physical activities.
Dr. Mo Athar
