Surgery may be considered if you have bunions. However, athletes, children, and people with health problems such as diabetes, rheumatoid arthritis, neuromuscular disorders (such as muscular dystrophy), or circulatory problems generally are advised to take a conservative approach when considering foot surgery. This information may not apply to them.

Consider the following when making your decision:

• Surgery generally is not considered unless you have already tried making changes in footwear and other nonsurgical treatments (such as using pads to cushion the painful area), and these did not relieve the pain.
• Surgery may be appropriate if you have:
  • Severe pain in the toe that interferes with your daily activities, and nonsurgical treatments have failed.
  • A severely deformed foot that interferes with your daily activities.
• The outcome of your surgery cannot be predicted. The success of surgery for bunions has not been widely studied. The specific outcomes and risks vary depending on the type of surgery, your surgeon's experience, and the severity of the deformity.
• Your expectations play a large role in how satisfied you are with the results of surgery. If you want surgery primarily to improve the way your foot looks, you may be less satisfied with the outcome. One-quarter to one-third of people having surgery for bunions are disappointed in the result, despite an improvement in pain and the degree of deformity.¹

What is a bunion?

A bunion (hallux valgus) is an enlargement of the joint at the base of the big toe. If you have a bunion, you will notice a bump on your big toe joint. The big toe may turn in toward the second toe (displacement), and the tissues surrounding the joint may be swollen and tender.

See an illustration of a bunion.

What are the risks of bunions?

A bunion can cause discomfort and pain and may make it difficult to walk. Shoes may rub on the bunion, causing pain, blisters, calluses, or sores. At the bunion location, a bacterial infection of the skin (cellulitis) or bone (osteomyelitis) may occur, especially if you have diabetes or peripheral arterial disease. If you have one of these conditions and sores develop, contact your health professional.

The appearance of a bunion may be embarrassing for some people.

What are the types of bunion surgery?

There are over 100 surgeries for bunions. Research does not indicate which type of surgery is best-surgery needs to be specific to your condition. More than one procedure may be done at the same time.

The general types of bunion surgery are:

• Removal of part of the metatarsal head (the part of the foot that is bulging out). This procedure is called exostectomy or bunionectomy.
• Realignment of the soft tissues (ligaments) around the big toe joint.
• Removal of a small wedge of bone from the foot (metatarsal osteotomy) or from the toe (phalangeal osteotomy).
• Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At the metatarsophalangeal joint, both the big toe and metatarsal bones are reshaped (resection arthroplasty).
• Fusion (arthrodesis) of the big toe joint.
• Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure).
• Implant insertion of all or part of an artificial joint.

What are the possible complications of bunion surgery?

Complications of surgery may include:

• Infection in the soft tissue or bone of the foot.
• Side effects from anesthetic medications.
• Recurrence of the bunion.
• An outward or upward bend in the big toe.
• Decreased feeling or sensation, numbness or tingling, or burning in the toe from damage to nerves.
• Damage to the tendons that pull the big toe up or down.
• A shorter big toe, if bone is removed.
• Restricted movement or stiffness of the big toe joint (may be an expected outcome of some types of surgery).
• Persistent pain and swelling.
• Degenerative joint disease (arthritis) or avascular necrosis (disruption of the blood supply to the bone) after surgery.
• Development of a callus on the bottom of the foot.

Is bunion surgery effective?

The effectiveness of surgery for bunions has not been widely studied. It depends on the type of surgery, the surgeon's experience, and the severity of the deformity. It also depends on what you expect from surgery.

In a review of bunion surgeries, 25% to 33% of people who had surgery were disappointed in the result, despite an improvement in pain and the degree of deformity.¹

If you need more information, see the topic Bunions.

Your choices are:

• Try nonsurgical treatments, such as wearing roomy footwear; using pads, arch supports, or orthotics to cushion the painful area; limiting or modifying activities that cause pain; and taking pain medication.
• Have bunion surgery.

The decision about whether to have surgery takes into account your personal feelings and the medical facts.

Deciding about surgery for bunions

Reasons to have surgery for bunions

Reasons not to have surgery for bunions

You have tried nonsurgical treatments, and they have not been effective. You have severe pain or a severely deformed foot that interferes with your daily activities. Surgery may allow you to walk and wear properly fitted shoes more easily and comfortably. For some bunions, surgery is effective in relieving pain and restoring the bone alignment. Are there other reasons you might want to have surgery?

The outcome of your surgery cannot be predicted. Whether it is effective will depend on the type of surgery you have, your surgeon's level of experience, and the severity of your deformity. Surgery may not help you. A review reports that 25% to 33% of those who had surgery were disappointed in the result, despite an improvement in pain and the degree of deformity.1 If you want surgery primarily to improve the way your foot looks, you may be dissatisfied with the outcome. Bunions may come back after surgery, especially if you continue to wear the types of shoes that contributed to the problem. Surgery may reduce the flexibility of the big toe joint, which may be a concern if you are active and need a full range of motion in the big toe. Complications may include infection of the tissue or bone of the foot; an outward bend in the big toe; decreased feeling, numbness, or tingling in the big toe; and damage to the tendons in the big toe. Are there other reasons you might not want to have surgery?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for bunions. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I understand that my bunion may return after surgery.	Yes	No	Unsure
I know there are risks involved in having surgery.	Yes	No	Unsure
I understand that surgery may not improve the appearance of my foot.	Yes	No	Unsure
I have tried wearing roomy footwear, using pads to cushion the painful area, limiting or modifying activities that cause pain, and taking pain medication and my toe is still very painful.	Yes	No	Unsure
The pain is affecting my quality of life.	Yes	No	Unsure
I know that the success of surgery cannot be predicted.	Yes	No	Unsure
I understand that my expectations of the surgery may influence my satisfaction with the outcome. I have discussed this with my health professional.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for bunions.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery

Leaning toward NOT having surgery

Citations

1. Ferrari J, et al. (2005). Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.

Author	Colleen Cronin
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Terrina Vail
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
Last Updated	March 20, 2006