Once you start developing a bunion, there's no way to predict whether it will progress to the point of causing pain, or even if it will progress at all. So if a doctor tells you that you need surgery immediately, be wary, Baumhauer says. "Nothing needs to be done stat," she says. "This isn't like appendicitis." Another red flag: doctors who want to operate on bunions that aren't causing pain. "It's all around pain, not around looks," Baumhauer says. And, she adds, it shouldn't be occasional pain, like once a month or even once a week. Surgery is justified only if you have pain most of the time. "If you can put on reasonable shoes and run and jump and play," she says, "don't have surgery."
 
One study, a 2004 review of bunion treatments by the nonprofit Cochrane Collaboration, found that as many as 33 percent of patients were dissatisfied after surgery. Baumhauer suspects that many of these patients might be unhappy not because of botched surgery, but because they weren't appropriate candidates for surgery in the first place. Their risks of scarring or nerve damage, for example, may have outweighed the benefits of a merely cosmetic improvement. "These complications are very hard to swallow if you didn't need the surgery to begin with," she says. With patients whose pain is debilitating, the satisfaction rate could be much higher, Baumhauer says. "Good surgeons will actually have pretty good results because they will have screened out all the people who don't need surgery," she says.

If your bunions are causing pain, Baumhauer advises seeing a fellowship-trained foot and ankle surgeon. A good surgeon should suggest first trying over-the-counter inserts along with shoes that are wide enough to accommodate the bunion. Anti-inflammatory medication can also help. If the pain persists, surgery would then be a reasonable next step. But Baumhauer says patients should always get a second opinion.

And to the many women suffering from bunions who are tempted to squeeze their feets into strappy shoes this season: good news. Ballet flats with rounded toes are in fashion. Substitute them for your stillettos during the holidays and you can keep your toes covered, and comfortable, and still look stylish.

To learn more about bunions and how to treat them, check out the web sites for The American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot & Ankle Society.

© 2007