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Does My Bunion Need Surgery?

Elizabeth Cody, MD, foot and ankle surgeon at HSS.
Elizabeth Cody, MD, foot and ankle surgeon at HSS. Photo Credit: HSS

Hallux valgus (or “bunion”) deformities are extremely common. They usually develop over long periods of time, exacerbated by certain shoes (narrow toe boxes, heels) or related foot deformities (such as flatfoot). However, they can also show up in younger individuals, even adolescents, who have a family history of bunions.

While many people don’t like the look of their bunions, most bunions do not cause people pain. The best way to avoid pain (and surgery) is to avoid the kinds of shoes that cause pain! Usually this means wearing wide toe box shoes. However, for some patients, this is not enough. When the bunion causes pain on a daily basis, and there are few shoes that can be worn comfortably, discussing surgery is reasonable.

What if your bunion doesn’t hurt, but other parts of your foot do? There are a lot of patients with bunions who have pain in other parts of their foot, such as under the ball of the foot, on the top of the foot, or in hammertoes. Often, these other types of pain are directly related to the bunion. Because the big toe does not function normally in the setting of a bunion, the rest of the foot can get overloaded, putting a lot of stress on the lesser metatarsals (leading to pain under the ball of the foot, or “metatarsalgia”) and on the midfoot (leading to arthritis and pain in the long term). With the big toe drifting towards the lesser toes, the lesser toes get crowded and can start to “hammer” or curl up to get out of the way. Over time, these toe deformities can get stiff and painful. Surgery can be necessary if nonoperative treatments, most importantly shoe modifications, fail to give relief. In these cases, it is usually necessary to fix the bunion as well, even if it is not painful, because it is the root cause of the problem.

Will your bunion get worse over time? There is a good chance it will, and it is easier to fix the bunion before secondary problems — such as hammertoes and arthritis — develop. You might be able to slow down worsening by wearing better shoes, but ultimately the only way to “fix” the bunion is with surgery.

To summarize, bunions can be a very complex problem, and every bunion is different. There are numerous types of surgeries to fix bunions and they are not “one size fits all.” And even with the best surgeons, bunion surgery doesn’t always have good outcomes — it should be considered only if the bunion is significantly limiting your activity and/or footwear. If you are considering surgery, getting an evaluation from an orthopedic foot and ankle surgeon trained in multiple techniques is a good idea.

Through HSS Orthopedics at Stamford Health, I am privileged to now be able to make world-class care more convenient for Fairfield County residents. My office is at the HSS Stamford Outpatient Center at Chelsea Piers, and my colleagues and I perform surgeries at both Tully Health Center and Stamford Hospital, in addition to Hospital for Special Surgery in Manhattan.