A bunion is more than a bump on the side of the foot. It is a change in the alignment of the big toe and the first metatarsal that can gradually affect how the entire front of the foot works. Some patients come to us because the bunion hurts. Others are more concerned that their shoes no longer fit, the big toe is beginning to cross over the second toe, or the foot is changing shape.
We often see patients who have tried to simply “live with it” until everyday shoes, walking, exercise, or standing become uncomfortable. The decision to treat a bunion is based less on how it looks on an X-ray and more on whether the deformity is causing pain, pressure, or functional problems.
Anatomy
The big toe and the first ray of the foot play an important role in balance and push-off when we walk. The first metatarsal, the big toe, the sesamoid bones beneath the joint, and the surrounding tendons, ligaments, and joint capsule all work together to keep the toe aligned.
With hallux valgus, that balance changes. The first metatarsal gradually moves toward the inside of the foot while the big toe moves toward the smaller toes. The soft tissues around the joint adapt to this new position, which can make the deformity progressively harder to correct with simple measures.
The visible “bump” is therefore not simply extra bone that can be shaved away. It is part of a larger alignment problem.
What a Bunion Looks and Feels Like
The most obvious finding is usually a prominence along the inside of the foot at the base of the big toe. The skin over the area may become red, irritated, or thickened from repeated contact with footwear.
Patients describe the symptoms in different ways. Some point directly to the bunion and describe aching or burning after standing or walking. Others primarily notice pressure from shoes. As the deformity progresses, the big toe can crowd or overlap the second toe, creating additional pressure points, calluses, or other toe deformities.
Not every bunion hurts. A visible deformity by itself does not necessarily mean that surgery is needed.
Why Bunions Develop
Hallux valgus usually develops from a combination of factors rather than one single cause.
Genetics can play an important role, which is why we frequently see bunions run in families. The shape and stability of the first ray, flatfoot mechanics, ligamentous laxity, and the shape of the joint can all influence how the deformity develops.
Footwear can make the problem more symptomatic. Narrow shoes and high heels place the toes in a confined position and increase pressure over the bunion. Ballet and other activities that repeatedly place stress on the front of the foot can also contribute.
Inflammatory conditions such as rheumatoid arthritis can produce a different type of bunion deformity and may change how we approach treatment.
What We Look for at the First Visit
We start by looking at the foot while you are standing and walking. We want to see how the big toe sits in relation to the second toe, how the first ray is positioned, whether there is flatfoot or another alignment issue, and where pressure is developing.
We then examine the bunion itself, the flexibility of the big toe joint, the position of the sesamoids, and the overall mobility of the first ray. We also look for calluses, transfer pain beneath the smaller metatarsals, and associated toe deformities.
Weight-bearing X-rays are particularly important because they show the foot under the conditions in which it actually functions. We assess the alignment of the first and second metatarsals, the position of the big toe, the sesamoid position, and whether there is arthritis or another structural problem that needs to be addressed.
What the X-Ray Classification Tells Us
Bunions are commonly described as mild, moderate, or severe based on measurements taken from weight-bearing X-rays. The hallux valgus angle and intermetatarsal angle help describe the amount of deformity, while the position of the sesamoids provides additional information.
These measurements help us select an appropriate operation when surgery is necessary, but the number on an X-ray is not the entire decision.
Two feet with similar measurements can require different treatment because their joint mobility, symptoms, activity demands, and underlying mechanics may be different. Our goal is to understand the entire foot rather than treat an X-ray measurement in isolation.
Conditions That Can Look Like a Bunion
Not every painful bump near the big toe is a straightforward hallux valgus deformity.
Hallux rigidus causes pain and stiffness at the big toe joint, but the underlying problem is arthritis rather than the same alignment pattern seen with a bunion. Gout can cause sudden inflammation and severe tenderness around the joint. Rheumatoid arthritis can create inflammatory deformity involving multiple joints. Hallux varus, in which the big toe points inward, is most often seen after previous bunion surgery.
Distinguishing these conditions matters because the treatment can be very different.
Starting With Pressure Relief
When a bunion is painful but does not require surgery, our first goal is to reduce the forces irritating the joint.
A shoe with a wider toe box and lower heel can make a substantial difference because it gives the big toe and bunion more room. Bunion pads, toe spacers, and orthotic devices can sometimes reduce pressure or improve comfort.
Stretching and targeted physical therapy may help maintain joint mobility and improve the way the foot functions. Medication or an injection may be considered when inflammation is contributing to symptoms.
These treatments can make the foot feel better, but they do not permanently straighten an established bunion.
When is Surgery Reasonable
We do not recommend bunion surgery simply because a bunion looks large.
The line we use is straightforward: the deformity needs to be causing meaningful pain or functional limitations that have not improved adequately with appropriate nonsurgical treatment.
When that is true, surgery is designed to correct the underlying alignment rather than simply remove the visible bump.
The operation depends on the structure of the deformity. Some patients can be treated with a distal first-metatarsal osteotomy. Larger or more complex deformities may require a proximal osteotomy or a combination of procedures. When there is significant instability at the first tarsometatarsal joint, a Lapidus procedure, which fuses that joint while correcting the alignment, may be appropriate.
Soft-tissue balancing around the big toe is often performed at the same time to help restore the joint to a functional position.
For younger patients whose bones are still growing, we are generally more cautious about surgery because growth and ongoing structural development can affect the result.
Recovery
Recovery depends on the procedure performed and the stability of the correction.
The early period usually involves a protective surgical shoe or boot, elevation, swelling control, and restrictions on activity. Weight-bearing instructions vary according to the operation, so we give each patient a specific postoperative plan rather than treating every bunion surgery the same way.
As healing progresses, we gradually work toward normal footwear, walking mechanics, strength, and motion of the big toe. Physical therapy may be used when appropriate.
The discouraging part for many patients is that the foot can look swollen for a long time even when the bone is healing appropriately. Returning to a comfortable shoe is not the same thing as being completely recovered, and residual swelling can continue well beyond the early postoperative period.
Recurrence and Other Possible Problems
Bunion surgery can provide significant improvement, but no operation eliminates the possibility of recurrence.
Other potential problems include stiffness, nerve irritation, overcorrection into hallux varus, continued pain beneath the smaller toes, infection, or problems with bone healing. The risk of recurrence is one reason we pay attention to the underlying mechanics of the foot rather than simply correcting the visible bump.
If flatfoot, first-ray instability, or another structural problem is contributing to the deformity, that issue may need to be addressed as part of the surgical plan.
What Happens If We Leave It Alone
A painless bunion does not necessarily need treatment. However, a symptomatic bunion can become increasingly difficult to accommodate in normal footwear as the deformity progresses.
Over time, patients may develop more pressure over the bunion, crowding or overlap of the lesser toes, calluses, or pain beneath the smaller metatarsals. More advanced deformity can also limit the available surgical options and make correction more involved.
The goal of early evaluation is not automatically to recommend surgery. It is to understand what is changing and determine whether anything needs to be done.
What a Good Outcome Means
A successful bunion treatment is not simply an X-ray showing a straighter toe.
We want our patients to be able to wear appropriate shoes comfortably, walk without the pain that brought them to us, return to their normal activities, and have a foot that functions well for their daily demands.
For some patients, that means nonsurgical treatment and learning how to control pressure on the bunion. For others, it means correcting the deformity surgically. The right treatment is the one that addresses the reason the patient is having trouble—not simply the appearance of the foot.
When We Recommend an Evaluation
We recommend an evaluation when bunion pain is interfering with walking, exercise, standing, work, or footwear, or when the big toe is beginning to crowd the second toe.
A painful or rapidly changing deformity deserves attention, particularly when swelling, redness, or significant difficulty bearing weight develops. Sudden severe pain, an acute injury with visible deformity, or signs of infection such as spreading redness, warmth, or drainage require more urgent assessment.
Our goal is to evaluate the foot before the problem dictates what treatment is possible and to choose the least invasive approach that can realistically provide lasting relief.
Do you have more questions?
What is a Bunion? What is Hallux Valgus?
A bunion is a bony bump that forms on the joint at the base of the big toe. It occurs when the big toe pushes against the next toe, forcing the joint of the big toe to get larger and stick out. This condition is often associated with the misalignment of the bones in the foot, leading to the formation of the bunion. This is also called hallux valgus deformity. Over time the metatarsal head (bony bump) will tend to drift and become more prominent.
What do patients with a Bunion feel?
Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will also tend to have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.
What are the symptoms of a bunion?
Symptoms of bunions may include pain, swelling, redness, and restricted movement of the big toe. In some cases, bunions may not cause any discomfort, but they can still affect the alignment of the toes and the overall structure of the foot. Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will tend to also have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.
What causes a bunion?
Bunions can be caused by various factors, including genetics, improper footwear, and certain foot conditions. High-heeled shoes and narrow-toed shoes can contribute to the development or worsening of bunions by squeezing the toes together. The pressure on the joint can lead to inflammation, pain, and the characteristic bony bump.
How do you diagnose a bunion / Hallux valgus?
Most bunion are diagnosed on clinical examination and X-rays.
What criteria is used to diagnose hallux valgus (Bunion)?
Your foot has a normal amount of outward angulation at the big toes joint. Less than 15 degrees is considered normal. This is called a Hallux Valgus Angle. 15-30 degrees is considered moderate deformity. More than 30 degrees is considered severe deformity. More than 40 degrees is considered a very severe deformity. We also use a measurement called a intermetatarsal angle. This is also elevated in hallux valgus deformity. Normally it is less than 9 degrees, but it can be elevated in hallux valgus. Treatment options change depending on the severity of your deformity.
What are treatment options for a bunion? Is there any treatment for bunions?
Treatment options for a bunions / Hallux Valgus include operative and non operative options. The goal of treatment is to reduce pain, increase mobility, and restore function. We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a difference. This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing. There are low profile braces that can help correct the position of the toes. These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.
What are non-operative treatments for a bunion? What is the treatment for bunions without surgery?
We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a difference. This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing. There are low profile braces that can help correct the position of the toes. These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.
Do non-surgical bunion treatments work?
In most cases of hallux valgus / bunions the deformity tends to get worse and worse. This will likely happen over years. As this occurs, your pain will tend to be more frequent and more severe. Non-operative treatment can help in less severe cases of hallux valgus. As the deformity worsens, as symptoms progress, non-operative measures are more likely to fail. Surgery is more likely indicated in severe cases.
What is Lapiplasty Bunion Surgery?
Lapiplasty is a type of bunion correction surgery. It an exciting new type of bunion correction that utilizes special guides / jigs to re-align the foot. It is combined with release of tight soft tissue structures and tightening of lax soft tissue structures. In doing this it corrects the bunion deformity.
How does Lapiplasty work?
The bunion is caused by a rotation and abduction deformity at the tarsometatarsal joint. We make and incision here, release the joint, and make bony cuts to allow the deformity to be corrected. We then apply places to hold it in this position, while the joint fuses. The corrects the deformity. We then make incision around the bunion to release the tight structures in between the 1 st and 2 nd toes. This can usually be done with a small incision and a releasing device. In some cases we have to make an incision over the bunion, remove excess bone, and tighten the soft tissue (capsule) on this side to correct the deformity further. Occasionally, in severe deformity, we have to make a bony cut in the proximal phalanx as well. This is usually fixed with a screw.
What to expect after Lapiplasty surgery? How long is recovery after Lapiplasty?
The surgery itself typically takes 1-2h and can be done as an outpatient procedure. You go home the same day in most cases. Following surgery, you will have a dressing on your incision and a cast on your foot. Ideally the area should remain completely dry until the staples / sutures are removed (2-3 weeks after surgery). We see you at 2 weeks after surgery to remove sutures and change the cast. You will go into a pneumatic walking boot at 2 weeks after surgery. We allow the bones to heal partially before you start weight bear. This means you start walking / weight bearing in a walking boot at 4 weeks post surgery. Physical therapy typically starts around this time as well. Surgery is painful. Most of the pain is experienced in the first few days. We give you strong pain medication and a pain management plan to address this. Swelling management is paramount. The foot will swell greatly after foot surgery. Icing and elevation are imperative. After the firstweek the pain tends to improve rapidly. I anticipate at two weeks post surgery the pain is much better. At 6 weeks most the pain should be gone. Swelling may be present for 6+ months after surgery. Eventually this returns to normal levels. This is the case for all foot surgery. Most patients are relatively pain free and have near full function of the foot around 2-3months after Lapiplasty.
Does Lapiplasty work?
Many studies have shown that Lapiplasty reliably corrects the deformity that cause bunion related pain. Furthermore, early results suggest that patient have excellent reduction of pain and are able to mobilize sooner than other methods of bunion correction.
Who is not a candidate for Lapiplasty?
Patient who would not be a good candidate for Lapiplasty are the same patient who are not good candidates for foot surgery. This includes patients with vascular disease of the lower limb, diabetes, end stage renal failure, smokers, and patient with a history of poor wound healing. The surgery would also be inappropriate in those patients who already have arthritis of the 1 st MTP joint (Bunion joint). Other foot deformities may preclude us from doing this surgery as well.
Are you put to sleep for Lapiplasty bunion surgery?
Typically, yes. Most of the time this surgery is done under a general anesthetic. Often it will be combining with peripheral nerve blocks for pain control.
Is Lapiplasty surgery painful?
It is as painful as most foot surgeries. However, we do our best to control your acute pain. This is done though nerve blocks, local anesthetic, and pain medication. Typically, after the 1-2 weeks, the pain is very manageable. The first few days are typically the worse. Most patients require opioid medication during this time. However, after that, most patients are able to cope with Acetaminophen and an anti-inflammatory.
How long does Lapiplasty bunion surgery take?
1-2 hours
What is the difference between Lapiplasty and regular bunion surgery?
Lapiplasty differed in the sense that the procedure is systematic. The guides and jigs used to correct deformity work well for all patients, all deformities, and all shapes of foot. They allow for reliable fixation. There is less guess work and more accuracy compared to traditional bunion surgery. It is success is quickly allowing it to become the most commonly performed bunion surgery in recent years.
Can bunions come back after Lapiplasty?
Bunions can recur after any surgery. However, this is usually because bunion correction is done at a young age. The younger you are, the more likely it will recur. Lapiplasty is a relatively new procedure, and the long-term recurrence rates are not known. However, recurrence rates for Lapidus procedures (on which the Lapiplasty is based) are very low.
Can Lapiplasty correct hammer toes?
Typically, no.
Can I wear heels after Lapiplasty?
Once you are fully recovered, yes.
Can you run after Lapiplasty?
Once you are fully recovered, yes.
How long after Lapiplasty can I drive? When can I drive after Lapiplasty?
Typically, you can start driving once the walking boot is discontinued. This is usually approximately 6 weeks after surgery
How long after Lapiplasty walk I drive? When can I walk after Lapiplasty?
Typically, patients are started walking / weight bearing approximately 4 weeks after surgery.
How long are you in a boot with Lapiplasty?
4-8 weeks
Is Lapiplasty covered by insurance?
Yes
Is Lapiplasty covered by Medicare?
Yes.
How much does Lapiplasty cost?
This varies from person to person depending on the insurance plan. We are happy to work with all insurance and figure out a solution to allow us to do this for you. Our billing agents are very helpful in this regard. Please feel free to have a conversation with one of them.
Who does Lapiplasty near me?
We can do the Lapiplasty procedure for you. Our foot and ankle specialist is well-versed in this procedure.
