To consistentlyand successfully treat musculoskeletal problems, the orthopedic surgeon must make a proper diagnosis that includes an understanding of the etiology and all structural components of a deformity, choose the proper surgical procedure from an often numerous list of possible treatment options, and properly perform the procedure chosen. References that describe over 120 surgical procedures that have been published for the correction of bunion deformities either means that the foot and ankle community has an intimate understanding of a very complex and heterogeneous deformity and has determined that this vast number of procedures is necessary to deal with this diversity or that we simply do not understand, or have significant misconceptions of, the etiology and source of patient complaints with bunions and that we widely differ in our interpretation of the physical examination findings and radiographic evaluation. This, in turn, has allowed us to devise so many surgical procedures with each attempting to address our own individual concepts of bunion deformities. The assessment and treatment of bunion deformities has traditionally been based on an analysis of the correction of radiographic angular abnormalities or measurement of patient satisfaction after a given surgical procedure. Most papers even try to comment on etiology that use the word "multifactorial" when describing how bunions form and progress. Rather than focus on a surgical procedure to fix radiographic angular abnormalities, I have developed an algorithm to correct bunion deformities that is based on suspected etiology that is being more carefully investigated in ongoing research.
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