Juvenile hallux valgus is a complex condition that is associated with multiple forefoot abnormalities and can be accompanied by a flexible flat foot. Initial treatment remains conservative with large toe box shoes, pain control, stretching, taping, or spacers. When indicated, surgical treatment is controversial because of the greater than 100 described surgical procedures and a historically high prevalence of recurrence. However, more recent reviews of surgical techniques for juvenile bunions show less recurrence than previously reported. The percutaneous distal metatarsal osteotomy is one procedure that offers many advantages to correcting adolescent hallux valgus deformities including minimal scar, immediate weight bearing, and effectiveness at correcting the deformity in a reproducible manner. The purpose of this paper is to review the management of juvenile/adolescent bunions and share technical pearls for the successful treatment with a percutaneous distal metatarsal osteotomy. Juvenile bunions are complex deformities that are not “younger” versions of adult bunions because of an increased dysplastic metatarsal articular angle. Lesser toe deformities may accompany the obvious hallux valgus deformity. Historically high rates of recurrence for surgical treatment are decreasing with improved techniques such as percutaneous distal metatarsal osteotomy.