Simple excision of the medial eminence removes the pressure point of which the patient complains. It is appropriate in the occasional patient in which the median eminence is enlarged but there is no metatarsus primus interphalangeus. However, it does not correct overall first ray alignment.
There is only one cohort study of the Silver procedure. Kitaoka et al (1991) found that 41% of 31 patients (49 feet) studied an average of 5 years post-operatively were dissatisfied with the result, usually due to recurrent deformity. Good results were obtained in patients with a prominent medial eminence but no actual hallux valgus.
Scranton et al (1995) found that one of their largest groups among patients with failed bunion surgery were patients who had had a Silver procedure and recurred because the metatarsus primus varus was not corrected. However, the total number of Silver procedures from which these patients were drawn (the denominator for the failure rate) is not specified.
We suggest the Silver procedure is not recommended in true hallux valgus