This patient presented to our office with a large painful bunion of the left foot. During the in office consultation we noted that the 1st metatarsal was also hyper-mobile. Hyper-mobile means that the first metatarsal moved up and down too easily with minimal pressure. Looking at the x-ray on the left you can see how much the the first metatarsal has shifted away from the second. This type of deformity does not happen over night, but may take many years to develop. We decided that a proximal osteotomy with internal fixation consisting of both screws and a plate would be the procedure of choice. The surgery was performed and we corrected the deformity utilizing a Lapidus type bunionectomy. From the x-ray you can also see that minimal shortening was achieved along the first metatarsal.