Why Is Bunion Surgery Not Recommended? What Has Changed

You have probably heard a story about months on crutches or a bunion that returned. We answer those stories below, but results come first. If you are still deciding about your own foot, start with do I need bunion surgery? For how the operations work, see bunion surgery.

Is bunion surgery worth it? What the results show

Pain and satisfaction. Most patients have less foot pain after bunion surgery.^[4] In the 209-person trial above, the surgery group had the fewest painful days and the fewest shoe problems, and it scored best on function and on satisfaction with treatment.^[2] A Cochrane review found only one trial comparing surgery with no treatment (140 people), which appears to be this same trial. Average pain at 12 months was 21 out of 100 after surgery and 39 without it, and people rated their treatment success 80 out of 100 compared with 61.^[5]

Correction. The common operations correct the bone about equally well. Across techniques, foot scores rose by about 34 points on a 100-point scale, to between about 81 and 90.^[6]

What has changed in bunion surgery?

Correction in three dimensions

The long bone behind the big toe, the first metatarsal, often rolls as well as drifts. On CT scans, up to 87% of bunions show this rotation. It also helps explain the out-of-place sesamoids (two small bones under the big toe joint), one of the most important factors for a bunion coming back.^[7]

“3D correction” (triplanar correction) means treating the deformity in all three directions. One way is a Lapidus procedure, which fuses a joint at the base of the first metatarsal. Early results are encouraging:

• In a study at seven US centers, 173 people were treated and 139 reached the four-year visit. Recurrence was 0.8% when counted as a big toe angle above 20 degrees, and 8.4% when counted above 15 degrees. People put weight on the foot in a boot after about eight days on average.^[8]
• An earlier report from that study, covering 117 people, found a return to athletic shoes at about 45 days and to unrestricted activity at about 121 days. About 14% had a complication, mostly related to hardware, and 6% had another operation.^[9]

The US study had a single group with no comparison, and its sponsor sells the system tested.^[10] It shows what is possible, not that 3D correction beats other operations.

Smaller incisions

Minimally invasive surgery corrects the bone through a few small incisions. In a series of 729 feet treated by one surgeon and followed for about 2.6 years on average, the big toe angle fell from about 30 degrees to about 7, pain and function improved, recurrence was 4.5% (angle above 20 degrees) and complications occurred in 6.1%.^[11]

A 2025 review of 22 studies reported faster recovery and fewer wound problems than open surgery, with open surgery still preferred for severe bunions.^[12] See minimally invasive bunion surgery or our parent practice’s look at what the research says (external site).

Should you wait if a bunion hurts?

A bunion isn’t an emergency, but when pain is limiting your walking or your work, there is a good case for not waiting.

• Bunions don’t go away. They usually get worse over time.^[13] Non-surgical care treats the pain, not the deformity.^[5]
• Waiting helped few people. In the trial above, only 24% of people assigned to a one-year wait said they had improved.^[2]
• Living with it has a cost. Among 116 people with painful bunions that had never been treated, quality of life was below the general population’s on every measure, and physical function stood out.^[14]
• Pain tends to rise with severity. In a study of 1,700 people, 419 had bunions. Foot pain affected 33.6% of mild cases and 57.1% of severe ones.^[15]

The American College of Foot and Ankle Surgeons says that when non-surgical care fails to relieve bunion pain and the pain interferes with daily activities, it is time to discuss surgery, and that many people put up with that pain for years.^[13] We found no trial testing whether earlier surgery gives a better result, and in the 116-person study, quality of life didn’t track the size of the deformity.^[14] So let your pain and your limits drive the decision, not the X-ray.

Who is a good candidate, and who is not?

You may be a good candidate if:

• pain limits your everyday activities, including walking
• the big toe stays inflamed and swollen despite rest or medicine
• the big toe is drifting toward the other toes, or has become stiff
• changing shoes and taking anti-inflammatory medicine have not relieved the pain^[4]

Surgery is generally not a good fit:

• if the bunion doesn’t hurt. A bunion that doesn’t hurt doesn’t need surgery, and surgery should not be done for looks. Doctors do not recommend it just to keep a bunion from getting worse, and pain can develop after surgery even if there was none before.^[4]
• for a teenager who is still growing. There is a strong chance the bunion will return, so surgery is usually delayed until growth is nearly complete.^[1]
• until other risks are dealt with. Smoking raises the risk of wound infection and of bones not healing.^[16] Diabetes with complications, and nerve damage, raise the risk of infection.^[17]
• if you can’t protect the foot during recovery. Healing depends on it.

Why is bunion surgery not recommended by so many people?

The bad reputation has real roots, and they are the limits to weigh. In one group followed for about five years, 26% of patients were dissatisfied, and only about a third of feet had no symptoms at all.^[18] The Cochrane evidence is of low certainty, and quality of life barely differed.^[5] One overview put the overall complication rate at 18.5%, with problems such as pain in the ball of the foot, recurrence, joint stiffness, wound-healing trouble and a toe pushed too far the other way.^[6] Full recovery often takes up to six months, and some swelling for 6 months to a year is common. Shaving off the bump without realigning the bone often lets the deformity return.^[4] A strict analysis of seven controlled studies found no clinically important gain from small incisions, and its authors did not recommend them over traditional surgery.^[19]

Recurrence numbers also depend on how they are counted.^[3,20]

The angle is how far the big toe leans on an X-ray. Lower cutoffs give higher numbers, and the third review warned that the 4.9% figure may be too low because most of its studies were short.^[21] A small X-ray change is not the same as a bunion that hurts again, although in the five-year study recurrence went along with worse patient scores.^[18]

Common questions

Is bunion surgery worth it?

For most people whose bunion limits daily life after non-surgical care, yes. Most have less foot pain afterward, and about 11% of patients in a large review were dissatisfied.^[4,3] Results vary, and no surgeon can promise yours.

Can bunions be corrected without surgery?

No. Non-surgical care treats the pain, not the deformity.^[5] OrthoInfo says shoes and other simple care can help keep a bunion from getting worse, but a review found not enough good evidence that orthotics slow it down.^[1,22] Our parent practice explains non-surgical bunion care (external site).

How long is bunion surgery recovery?

Full recovery often takes up to six months.^[4] Our bunion surgery recovery timeline covers each stage.

Will my bunion come back after surgery?

It can, but it isn’t the usual result. In a review of 229 studies, the deformity came back in 4.9%.^[3]

The bottom line

If a bunion hurts and limits your life after non-surgical care, surgery is the answer that corrects it, and newer approaches also target the bone’s rotation. Dr. Ozturk is a double board certified Foot and Ankle Surgeon and podiatrist who sees patients in Lyndhurst, Paramus and Millburn. You can request an appointment to find out where your foot stands.