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By Richard Moy
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Bunions are far more widespread than many people realize.
A 2023 systematic review and meta-analysis of 45 studies involving more than 186 million participants estimated that nearly one in five people worldwide has hallux valgus, the deformity commonly associated with a bunion.
The prevalence rises to approximately 22.7 percent among people over 60, and is even higher among women, at 23.7 percent.
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This is not a minor or isolated foot problem. It is a widespread condition affecting millions of people and, for many patients, one that can interfere with footwear, daily activities, foot function, and quality of life, as a 2026 systematic review of patient experiences with hallux valgus documents.
Yet questions remain about how clearly patients are informed about their surgical options and the recovery they can expect.
Patients are still often warned to expect significant pain, prolonged immobility, swelling, restricted weight-bearing, and months of recovery.
If bunions are this common, shouldn't we be asking whether the standard approach to treating them has kept pace with what patients actually need?
Changing The Perception of Surgery
“Bunion surgery” is too broad a term to tell patients what they actually need to know.
There are multiple operations for correcting a bunion, each involving different approaches to bone correction, soft-tissue management, fixation, and postoperative rehabilitation.
A 2024 living systematic review and meta-analysis examined more than 100 surgical techniques and found that the most appropriate approach remains debated.
In my view, the choice of surgeon and procedure may be among the most important factors determining not only how the deformity is corrected, but how a patient recovers and ultimately returns to daily life.
Yet the public perception remains remarkably fixed. Bunion surgery is extremely painful, patients cannot walk for six to eight weeks, crutches or scooters are inevitable, swelling can keep them out of normal shoes for months, and stiffness or recurrence may follow.
For some, recovery can seem worse than the original problem. But should we still accept all of this as inevitable?
I don’t believe we should.
Patients often speak about bunion surgery as though every operation were essentially the same. They are not. One patient may undergo extensive bone work, soft-tissue dissection, and prolonged restricted weight-bearing. Another may undergo a procedure designed to preserve stability, minimize unnecessary tissue trauma, and permit early protected walking.
Corrective Surgery and Recovery One And The Same
Even if both patients say “I had bunion surgery,” true recovery is shaped by decisions made before and during the operation, not just after it ends.
A 2025 systematic review of rehabilitation interventions for hallux valgus surgery found that early postoperative weight-bearing appeared to improve patient outcomes, although the authors emphasized that the available evidence remains limited.
After more than three decades of performing bunion surgery, I have come to believe that correcting the deformity and recovering from the operation should not be viewed as two separate objectives. They should be planned together.
Certainly, the goal is to straighten the toe and restore proper alignment of the foot. But the operation should also aim to preserve joint motion, minimize unnecessary tissue injury, provide stable correction, and allow the patient to return to normal function as safely and efficiently as possible.
Rethinking What a Bunion Actually Is
We also need to rethink what a bunion actually is. It is much more than a bump on the side of the foot. That prominence is the visible sign of a complex structural problem involving the first metatarsal, great toe, sesamoid bones, and the soft tissues and tendons that influence alignment and motion.
A review of the anatomy and pathology of the hallucal-sesamoid complex describes the interconnected structures involved in the function of the great toe and the first metatarsophalangeal joint. Simply removing the bump does not necessarily correct the underlying deformity.
A successful operation must address alignment while preserving joint mechanics and balancing the forces acting on the great toe after surgery.
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That is why recurrence matters. One of the most common questions patients ask me is, “Will my bunion come back?”
Correcting the bone is only part of the challenge. The correction must remain stable as the patient returns to walking, work, exercise, shoes, and everyday life.
Bunion surgery should therefore be judged by more than how the foot looks immediately afterward. Does the correction last? Does the joint move comfortably? Is function restored? Can the patient return to the activities that matter to them? What did recovery actually feel like?
These questions matter far beyond orthopedics. Every person, regardless of where they live, ultimately depends on the ability to participate in daily life.
When medical decisions are poorly understood, patients can approach surgery expecting unnecessary pain and disability; when they understand their options and ask better questions, they can partake more meaningfully in decisions that shape their recovery and quality of life.
Pain control, tissue preservation, stable fixation, swelling management, and weight-bearing are not merely postoperative concerns. They are influenced by how an operation is planned and performed.
Some patients require restricted weight-bearing, but we should not automatically assume that weeks of immobility, dependence on crutches or scooters, severe pain, or prolonged reliance on strong medication must accompany every successful correction.
Patients deserve evidence of what recovery can actually look like, not simply a before-and-after X-ray, but what happens after anesthesia wears off, the following morning, weeks later, and years afterward.
That is the standard we should demand.
I have learned that patients are not simply asking us to straighten a toe. They are asking us to solve a problem without unnecessarily creating another one.
Dr. Richard Moy, DPM, is a Southern California foot and ankle surgeon who developed a virtually painless bunion-correction technique in 1992. The views expressed are the author's own.
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