Minimally Invasive Chevron and Akin (MICA)

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The MICA procedure is used to correct a mild-to-moderate hallux valgus and ease bunion pain.

What is the Minimally Invasive Chevron and Akin (MICA) procedure?

A Hallux Valgus, more commonly known as a bunion, is a large, protruding bump on the side of the big toe. Bunions can cause swelling, soreness and inflammation – although not all bunions are painful. A typical bunion procedure would be one or the other Chevron or Akin, but the MICA procedure is a two-phase bunion surgery designed to correct a mild-to-moderate hallux valgus and ease bunion pain. This safe, effective bunion treatment is usually performed under general anaesthesia and should allow you to return home the same day.

Chevron osteotomy procedure

Your surgeon will make a small incision at the base of your big toe and cut the metatarsal head, just behind the big toe joint, before gently moving the bone back into alignment. A small screw is inserted to stabilize the bone and prevent the bunion from reoccurring.

Akin osteotomy procedure

If the big toe has a prominent, bony growth, an Akin Osteotomy is often performed in conjunction with the Chevron surgery. During this procedure, your surgeon will remove excess bone from the side of the big toe. An additional procedure to tighten the soft tissue inside the joint or loosen tissue on the outside of the joint might also be required.




Reasons for bunions

Bunions occur when the metatarsal joint at the base of the big toe becomes misaligned. The big toe may angle toward the smaller toes, creating a crooked bump that usually gets larger over time. A bulging metatarsal bone can put pressure on the joint and wear down cartilage, making it increasingly difficult to walk or run without bunion or foot pain.

The most common cause for a bunion is the continued wearing of shoes that don’t fit correctly, such as shoes with a narrow, pointed toe box that squeeze the toes into unnatural positions and shoes that are too small. Bunions can also be caused by an inherited structural defect in the feet, injuries, stress on the foot, or sometimes by arthritis.

Women have about four times as many problems with their feet as men. High heels are partly to blame. Many times forcing feet into narrow, high-heeled shoes or shoes that are too small can cause hammertoes, an unsightly and often very painful bending of the toe, as well as bunions, a bony bump that forms on the joint at the base of the big toe.

What are the goals and benefits of bunion surgery?

The MICA procedure is an innovative new option for those suffering from a Bunion or hallux valgus.  It is an effective way to permanently treat the pain, soreness, stiffness and limited mobility caused by foot bunions. If you’re experiencing severe foot pain – even when wearing comfortable, supportive shoes – and the swelling and stiffness is affecting your daily activities, bunion surgery can provide relief. It can also prevent further damage to the joints and cartilage in your toe, which could eventually lead to arthritis.

Some of the benefits of the MICA procedure over traditional bunion surgery is that it offers a quicker recovery as there is no need to wait for the bone to fuse, less pain as the incision is smaller, more mobility sooner, you will be up and around in half the time.

What to expect with MICA surgery

The goal for bunion correction surgery is to relieve as much pain and discomfort as possible and correct the deformity by returning your toe to the correct position.

If your surgeon has determined that your bunion needs surgical intervention, the MICA surgical option may be for you.  This unique procedure was designed for precise bunion correction surgery. It allows the surgeon to accurately fix the bone and correct the soft tissue issues, which potentially leads to better results for patients. There is even the possibility of weight bearing shortly after surgery, only with the surgeon’s approval.

If you are in the process of deciding whether or not you should undergo bunion correction surgery, we want to ensure that you have all of the information you need to make the best choice. Surgery isn’t recommended unless the bunion is causing severe pain that interferes with and limits daily activities, your big toe is chronically inflamed and swollen and doesn’t improve with rest or medications, and failure to improve with the use of home remedies or non‐surgical treatments.

There are several surgical procedures available to correct bunions. They may involve repair of tendons and ligaments, removing swollen tissue from around the big toe joint, removing part of the bone to help straighten the big toe, and joining the bones of the affected joint permanently. Recovery from surgery varies by the type of surgery performed. Your doctor will choose the procedure best suited to your condition.

During the procedure the surgeon will make a small incision at the base of your big toe, then cut and re-align the metatarsal bone, remove any excess tissue or bony growths, and re-align the bone using a small screw for stabilization. Your surgeon will close the incision and bandage your foot.

After bunion surgery

You will be provided with a cast boot, prescription and a Cold Therapy Machine to aid in pain relief and to manage swelling while you heal.

Most patients can immediately put gentle weight on the affected foot if they wear a protective, post-surgical cast boot. Depending on the severity of your condition, you may need to use crutches for a few days or stay off the foot for 2-3 weeks. Each patient is different, so your surgeon will tell you the best way to protect your foot and enjoy a prompt, full recovery.

Benefits/risks of bunion surgery

The vast majority of patients who undergo bunion surgery or MICA say they are extremely happy with the procedure. While individual results may vary, this is a safe, minimally invasive and highly effective surgical procedure.  Bunion surgery relieves the pain, swelling and misalignment of the metatarsal bone and joint. You should be able to wear a comfortable and supportive shoe within 1-2 weeks after your procedure.

Minimal risks associated with bunion surgery can include infection, toe stiffness, neuroma (nerve pain), slow healing, and localized numbness. Your surgeon will provide detailed information and follow-up care to ensure you have the best possible outcome and enjoy lasting relief from foot and bunion pain.

Bunion symptoms

The symptoms of a bunion can include the following:

  • A bump that bulges on the outside of the base of the big toe
  • Swelling, redness and or soreness around the big toe joint
  • Corns or calluses where the big toe overlaps the second toe
  • Restricted and painful movement of the big toe
  • Skin thickening at the base of the big toe

Next Steps: Book your bunion surgery consultation

The first step is to have standing x-rays completed for both feet.  This can be arranged by your family physician. Not all diagnostic facilities do standing x-rays so make sure to ask before you go.

If you are ready to discuss your surgery needs with our board-certified surgeons, request a consultation today. During your consultation your patient care adviser will discuss:

  • Your medical history
  • Pre and post-operative care
  • Potential risks and complications


Toronto Resident
Patients who are residents of Ontario or are otherwise covered by the Ontario Health Insurance Plan (OHIP) are not eligible to access this procedure privately in the Toronto location.

Other Provinces
Patients who currently reside in British Columbia, Alberta, Saskatchewan, Manitoba, Northwest Territories, Nunavut, Yukon, Quebec, Newfoundland, Nova Scotia, New Brunswick and Prince Edward Island are eligible to access this procedure privately at the Toronto location.

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