If a bunion is stopping you from performing certain activities, it's reasonable to pursue surgery.
Bunions are one of the most common foot conditions among adults. It's estimated that about a third of adults in the U.S. have a bunion. They may be an eyesore for some people, but for others, they cause foot pain.
What is a bunion?
A bunion is a bony bump on the side of the foot at the base of the big toe. They form when pressure on the joint at the base of the big toe causes it to move out of place and shift toward the second toe. This shift usually occurs slowly over time and can worsen if it isn't treated. Bunions can develop in one or both feet.
One of the most common reasons bunions form is because someone is genetically predisposed to get them, says Dr. Gary Schmidt, a foot and ankle orthopedic surgeon with OrthoONE at Swedish Medical Center in Englewood, Colorado — part of our broader HCA Healthcare network. Some people have feet that are more likely to develop bunions because of their shape and structure.
Another common cause is wearing ill-fitting footwear for long periods of time. These include shoes that are too small or too constrictive in the toe box.
"If you look at how the forefoot becomes kind of pointy, similar to tight-fitting pointy shoes, that promotes bunions, especially in people who are genetically predisposed to them," Dr. Schmidt says.
Bunions are more common in women than men, he explains. However, many people with bunions have a family history. They usually develop in adulthood, but occasionally they form early in life.
Are there different types of bunions?
Although "bunion" is a generic term, a few different types of bunions can occur.
Juvenile bunions occur in children, particularly girls, between the ages of 10 and 15.
Acquired bunions occur over time, often due to ill-fitting footwear.
A tailor's bunion, or bunionette, forms on the outside of the pinky toe instead of the big toe. They get their name from tailors who sat cross-legged with the edge of their foot rubbing on the ground. The rubbing caused a bump to form on the little toe. They aren't as common as bunions and are usually caused by abnormal foot mechanics.
When should you consider bunion surgery?
For some people, bunions aren't painful. For others, they can cause a significant amount of pain. It's possible to have large bunions that aren't painful and small bunions that are.
"What's acceptable to some is not acceptable to others," Dr. Schmidt says. "If you're a barefoot, sandal-wearing person living in a more tropical climate, it may never bother you. But if you're a very active person, and you like to hike and cycle and things like that, you're not going to find hiking boots that are built like clown shoes." Much of the pain people have with bunions is from not being able to fit their shoes properly.
If you don't have pain and just don't like the way the bunion looks, surgery might not be the best option for you. "Those patients have shown not to do well with any surgical intervention, so we're kind of wary of that," Dr. Schmidt says.
It's also important to manage your expectations, Dr. Schmidt explains. The only way to get rid of bunions is to surgically correct them. Products like bunion regulators and toe spacers can help relieve pain, but they don't actually cure bunions. Once you remove them, your bunion will go back to normal. If wearing different shoes or modifying your activities stops working, it might be time to consider surgery.
Besides alleviating pain, bunion surgery realigns the forefoot and the foot's weight-bearing axis, which helps the foot function normally.
"If you look at the way the foot is built, most of the weight is supposed to go through the big toe," Dr. Schmidt says. "The further over that goes, the less it can participate in gait and walking. So by correcting the position, you correct the biomechanics of the foot."
How long does it take to recover from bunion surgery?
A common misconception people have about bunion surgery is that the recovery period is long and painful, especially for those who have a family history.
"Someone might come in and say, 'My grandma had her bunion fixed, and she was in bed for six weeks with horrible pain,'" Dr. Schmidt says. "They will relay that experience vicariously that it's a horribly painful, slow-healing, long, drawn-out process that lays you up for an extended period of time."
While that might have been true in the past, it isn't the case today, Dr. Schmidt explains. Now, better techniques and equipment reduce the pain and shorten the recovery period.
"We ask you to stay off the foot for two weeks, and at two weeks, we allow you weight-bearing. At four weeks, we're frequently done with you," he says. Those numbers can vary depending on what technique was used. While minimally invasive surgery has been one of the biggest advancements that allows for faster recovery, traditional procedures have also improved due to guided systems and improved hardware.
Is bunion surgery right for you?
Whether you need bunion surgery or not depends on how your bunion affects your everyday life. If you can do everything you want to do, you might not need surgery. But if it's stopping you from performing certain activities, it's reasonable to pursue surgery. "In those cases, if a patient has tried different things, and it hasn't really worked out, I think you should offer them a cure," Dr. Schmidt says.