When to consider bunion surgery?

This question comes up multiple times during our foot & ankle clinics. The answer is not always straight forward but most importantly it has to be discussed with each individual patient. For a successful outcome the response must factor in patient’s history, expectations and lifestyle. 


Will my bunions get worse?


The natural history of bunions is one of progression, unfortunately. This means that when they start appearing they will get worse with time. And this is due to the fact that the equilibrium of anatomical structures gets lost and so tendons and ligaments start pulling on the wrong direction and perpetuating the deforming forces. How fast the progression or how painful they will become is uncertain and varies for every patient.


Can I cure my bunions with toe correctors or orthotics?


The myth of bunion fixation with braces or other external devices is widespread. However it is all a big fat lie. 

Scientific evidence has shown that not only these devices do not change the natural history (i.e don’t slow down progression in the long term) but as soon as they are removed the toe returns to were it was. In other words, the realignment that toe correctors provide is only temporary while they are being used but not beyond that.1-2

The role that orthotics play in the treatment of bunions is purely symptomatic - to ease the pain or symptoms. These combined with adequate footwear are the mainstay of conservative treatment and can make bunions pain-free for a reasonable amount of time. These include bunion pads, toe spacers, bunion splints or braces)


Bunion surgery - when to have it?

  • You have tried several weeks or months of home remedies or care techniques with limited success and the pain continues.
  • You find it difficult to fit in shoes, and those that were comfortable before are not manageable anymore.
  • You are limited in your walking distance or cannot go about your daily activities.
  • Your bunions are getting worse and the deformity progressing.
  • You start developing pain or deformity of the 2nd toe next to the bunion - it might curl (hammer toe) or start with pain under the ball of the foot (metatarsalgia or plantar plate tear). If severe it might even cross over the big toe.


During your consultation you will be informed about the benefits of surgery and its minor risks or how to avoid and recognise them; the recovery time; alternatives to surgery; the results of similar cases to yours; and along with your surgeon you will decide upon the treatment that best suits your needs. No question will go unanswered.

1. https://jamanetwork.com/journals/jama/fullarticle/193839

2. https://journals.sagepub.com/doi/full/10.1080/03093640701669074