Bunion Blues Begone: A Podiatrist’s Guide to Happy Feet

August 2 2025

Say goodbye to bunion woes: Our latest article dives into all your treatment options, from conservative care to cutting-edge minimally invasive surgery. Discover how to get back on your feet and loving life!

Lori DeBlasi
Kevin Lam, DPM, FACFAS

It’s a common scenario in my podiatry practice: a patient walks in, often with a shoe kicked off, pointing to that unmistakable, often angry-looking bump at the base of their big toe “Doctor,” they’ll say, “what can we do about this bunion?”

As a podiatrist, addressing bunions is a significant part of my daily work, and for good reason. A bunion, or hallux valgus, isn’t a structural deformity of the foot where the big toe drifts inward towards the other toes, causing the joint at its base (the metatarsophalangeal, or MTP joint) to jut outward. This misalignment leads to pain, inflammation, difficulty finding comfortable shoes, and can significantly impact a person’s quality of life.

Understanding the root cause is the first step in effective treatment. While ill-fitting shoes, particularly high heels with pointed shoes, often get the blame, the primary culprit is typically genetics. If your parents or grandparents had bunions, you’re more predisposed. Other contributing factors include certain foot types (like flat feet), hypermobility, and inflammatory conditions such as rheumatoid arthritis. It’s crucial to understand that a bunion isn’t just an outgrowth of bone; it’s a progressive deformity that, if left untreated, tends to worsen over time.

Conservative Treatment Options

When a patient presents with a bunion, my initial approach is always conservative. My goal is to alleviate pain, prevent progression, and improve function without resorting to surgery, if possible. Education is key here. I spend time explaining the mechanics of the bunion and how certain lifestyle modifications can make a significant difference.

Footwear Modification

One of the most immediate and impactful recommendations is footwear modification. I emphasize the importance of shoes with a wide, deep toe box that allows the toes to splay naturally. High heels, pointed-toe shoes, and those with a shallow toe box are strongly discouraged as they exacerbate pressure on the MTP joint. For many patients, simply switching to more appropriate footwear can bring remarkable relief from pain and discomfort.

Orthotics are another corner of conservative care. Custom-made orthotics can help control abnormal foot mechanics that contribute to bunion development and progression. By providing support and cushioning, they can redistribute pressure more evenly across the foot, reducing stress on the big toe joint. Over-the-counter arch supports may offer some temporary relief, but a custom orthotic, molded to your unique foot structure, provides superior support and long-term benefits.

Anti-inflammatory Measures

For acute pain and inflammation, I often recommend anti-inflammatory measures. This can include rest, ice application, and over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. In some cases, if inflammation is severe, a corticosteroid injection directly into the joint can provide significant, albeit temporary relief. However, injections are not a long-term solution and are used judiciously due to potential side effects with repeated use.

Padding and Taping

Padding and taping can also offer symptomatic relief. Bunion pads, often made of felt or silicone, can cushion the prominent bunion and prevent irritation from footwear. Taping techniques can sometimes help to realign the big toe, reducing pressure on the joint. These are generally short-term solutions for comfort, not corrective treatments.

Physical Therapy and Exercises

Physical therapy and exercises can play a role, particularly in strengthening the intrinsic foot muscles and improving flexibility. While exercises won’t “fix” a bunion, they can help improve foot mechanics, reduce pain, and slow down the progression of the deformity. I often guide patients through exercises like toe spreads, marble pickups, and towel scrunches.

Surgical Treatment Options

However, despite our best conservative efforts, there comes a point for some patients where surgery becomes the most viable option. When a bunion significantly impairs a patient’s ability to walk, participate in daily activities, or causes persistent, debilitating pain that hasn’t responded to non-surgical treatments, I begin to discuss surgical correction, known as a bunionectomy.

It’s crucial to understand that bunion surgery is not a “one-size-fits-all” procedure. There are over 100 different surgical techniques, and the choice depends on several factors: the severity of the bunion, the degree of deformity, the patient’s age, activity level, and the presence of any other foot conditions. The goal of bunion surgery is to realign the joint, remove the bony prominence, and restore normal foot function.

Traditional Bunionectomy Approaches

Common surgical procedures include:

• Exostectomy: This is the simplest procedure, involving only the removal of the bony prominence. It’s typically reserved for very mild bunions without significant toe deviation.
• Osteotomy: This involves cutting and realigning the bone (usually the metatarsal bone) near the big toe joint. The bone is then stabilized with screws, pins, or plates while it heals. This is a very common approach and can be performed in various locations (e.g. at the head, shaft, or base of the metatarsal) depending on the specific deformity.
• Arthrodesis: In severe cases, particularly with significant arthritis in the big toe joint, fusion of the joint may be necessary. This involves removing damaged cartilage and joining the bones permanently, eliminating motion but also pain.
• Lapiplasty 3D Bunion Correction: This newer technique addresses the instability and rotation often present in the metatarsal bone, aiming for a more comprehensive, three-dimensional correction. It has shown promising results in reducing recurrence rates.

Minimally Invasive Bunion Surgery (MIS)

While traditional open bunionectomies involve a longer incision (typically 2-5 inches), a growing number of patients are seeking out minimally invasive bunion surgery (MIS), often referred to as “scarless” bunion surgery. This technique is gaining popularity due to its potential for reduced pain, swelling, and, as the name suggestions, a more aesthetically pleasing outcome with minimal to no visible scarring.

In MIS bunion surgery, the surgeon makes several tiny incisions, often just a few millimeters long. Through these small “keyholes,” specialized instruments and a tiny camera (endoscope) are inserted to visualize and correct the deformity. The bone is cut and realigned using a high-speed burr rather than a traditional saw, and screws or pins are used to stabilize the bones while they heal. The smaller incisions mean less disruption to the surrounding soft tissues, which can translate to less post-operative pain, less blood loss, and potentially a faster initial recovery.

Common MIS techniques include:

• Percutaneous Chevron Akin (PECA) technique: Often used for mild to moderate bunions, this involves precise cuts to the first metatarsal bone and the big toe bone through small incisions to correct alignment.
• Minimally Invasive Percutaneous Lapidus: For more severe bunions, this technique addresses instability closer to the arch, often involving fusion of a joint and bone cuts through tiny incisions. This can correct the bunion in multiple planes.

Recovery and Cost Considerations

Post-operative recovery varies depending on the procedure, but typically involves a period of non-weight-bearing or limited weight-bearing, followed by rehabilitation. Pain management is crucial, and physical therapy is often recommended to restore strength and range of motion. Full recovery can take several months, but the vast majority of patients experience significant pain relief and improved function.

While the appeal of minimal scarring and potentially faster recovery is strong, it’s important to remember that MIS bunion surgery is still bone surgery. Bone healing still takes time, typically 6-8 weeks for a complete union. While some MIS procedures allow for earlier weight-bearing in a special post-operative shoe compared to traditional open techniques (sometimes within days or weeks), full recovery and return to normal activities can still take several months. Patients should expect some swelling for an extended period, and adherence to post-operative instructions, including elevation, ice, and prescribed exercises, is critical for optimal results.

The cost of bunion surgery, whether traditional or minimally invasive, can vary widely depending on factors like the complexity of the procedure, the surgeon’s fees, anesthesia, facility charges (ambulatory surgery center versus hospital outpatient department), and geographic location. On average, bunionectomy can range from $6,000 to $11,000 per foot. Insurance typically covers bunion surgery if it’s deemed medically necessary due to pain or functional impairment, rather than purely for cosmetic reasons. Patients should always verify their coverage with their insurance provider.

Ultimately, the decision between traditional and minimally invasive bunion surgery, and indeed whether to have surgery at all, is a collaborative one between me and my patient. We discuss the pros and cons of each approach, the severity of the bunion, the patient’s lifestyle, and their expectations. My goal is to empower patients with information so they can make the best decision for their foot health and overall well-being. If you’re experiencing bunion pain, don’t hesitate to seek professional advice. Early intervention often leads to better outcomes, and with advancements in surgical techniques, there are more options than ever to get you back on your feet comfortably.

If you are suffering from bunion pain, contact Dr. DeBlasi’s office at (239) 430-3668 (FOOT) or schedule online at www.NaplesPodiatrist.com

Serving Southwest Florida Since 2005, Family Foot & Leg Center has multiple convenient locations throughout Collier, Lee, Charlotte, and Sarasota Counties. Offering pediatric to geriatric family care: Ingrown Toenails, Heel Pain, Bunions, Foot / Ankle Arthritis Pain, Plantar Fasciitis, Foot / Ankle Surgery, Custom Orthotics, and Diabetic Wound Care. In office X-rays, ultrasounds, and minor surgical suite exam rooms. Practice powered by EMR and advanced technologies.

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