The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Surgical correction of hallux valgus using minimal access techniques.

The guidance was considered for reassessment in October 2011 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.


Hallux valgus is a deformity of the big toe. The big toe tilts outwards, crowding the smaller toes, and a bony lump (called a bunion) appears on the inside of the foot.

Under local or general anaesthesia, one or more small cuts are made to insert bone-cutting instruments. These are used to remove the bunion and to divide one or more of the bones of the front of the foot. The divided bones may need to be stabilised with wires, screws or plates. The aim is to correct the tilting of the big toe. The operation is monitored by X-rays or an endoscope (a telescope for looking inside the body). Compared with standard (open) surgery, this procedure uses smaller cuts to the foot and X-rays or endoscopy to see inside the foot.

Coding recommendations

The OPCS-4 codes would depend on the exact procedure performed; although it is not possible to classify the size of incisions in OPCS-4, if an endoscope is utilised during the procedure or if some form of image control is required, then relevant additional Chapter ‘Y’ codes are assigned.

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