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Category: Bunion Introduction/Purpose: The orthopaedic literature is rife with reports of high failure rates following the surgical correction of juvenile bunion deformities. We contend that the reason for these poor outcomes is that although juvenile and adult bunion deformities have similar clinical appearances, the pathophysiology of the two is distinct. As such, successful surgical management of juvenile bunions requires greater understanding of this unique deformity in order to plan appropriate surgical correction. The first step in this process is to redefine the parameters that constitute the juvenile bunion. We propose that the distal metatarsal articular angle (DMAA) is the central defining characteristic of the juvenile bunion and that a higher DMAA may correlate with greater symptomatology in this population. Methods: An IRB approved retrospective analysis of prospectively enrolled patients between 10 and 18 years of age with bunion deformities was performed at a single pediatric institution over a two-year period. Patients with metabolic bone disease, neurologic disorders, and inflammatory arthritis were excluded. Demographic data was recorded and standardized weight-bearing radiographs were used to determine the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), hallux interphalangeus angle, metatarsal cuneiform angle (MCA), cuneiform obliquity, sesamoid position (SP), and joint congruency. Patient reported outcome measures (PROs) including the Oxford Foot and Ankle Questionnaire (OxAFQ-C), Foot and Ankle Ability Measure (FAAM), Foot and Ankle Outcome Score (FAOS), Pain Numeric Rating Scale Score (PNRS), and Functional Disability Inventory Score (FDI) were administered at initial presentation. Bivariate analysis using Spearman’s correlation was used to determine the association between individual deformity parameters and the relationship of those parameters to PRO’s. Results: 32 patients (57 feet) met inclusion criteria (average age of 14 years; range 11-17 years). 48/57 feet (84%) had an elevated DMAA (average 23.1° ± 7.8°). The DMAA correlated positively with the HVA (r= 0.734, p