The Ultimate Guide to Bunion Surgery

Clinically reviewed by David Lee, MD — Orthopedic foot and ankle surgeon at Commons Clinic Updated: March 2026 | Read time: 15 minutes

The Bump That Quietly Takes Over Your Feet — and Your Life

It probably started years ago. A slight bump at the base of your big toe that made certain shoes uncomfortable. You switched to wider shoes. Then you switched to different shoes entirely. Then you stopped wearing the shoes you wanted to wear and started wearing the shoes you could tolerate.

Now the bump is bigger. The big toe angles toward the second toe — maybe even overlapping it. The joint aches after a long day on your feet. Walking any real distance has become something you plan around rather than take for granted. And you've started to wonder whether this is something that will just keep getting worse.

It will. Bunions are a progressive structural deformity, meaning they do not correct themselves and they tend to worsen over time. The good news: modern bunion surgery has evolved dramatically. Techniques available today produce better correction, faster recovery, and more durable results than the bunion surgery of even 10 years ago — and many patients are walking in a surgical shoe the same day.

What Is a Bunion?

A bunion (hallux valgus) is a bony prominence that forms at the base of the big toe where it meets the foot — the first metatarsophalangeal (MTP) joint. But the bump itself is only part of the story. A bunion is actually a complex deformity involving the entire first ray of the foot.

What happens structurally: the first metatarsal bone (the long bone behind the big toe) drifts inward toward the midline of the body, while the big toe angles outward toward the second toe. This creates the characteristic bump on the inside of the foot — which is not new bone growth but rather the displaced metatarsal head becoming prominent under the skin.

As the deformity progresses, the joint becomes increasingly misaligned, the cartilage wears unevenly, the surrounding soft tissues stretch on one side and contract on the other, and the biomechanics of the entire forefoot change. This can lead to pain in the bunion joint itself, transfer metatarsalgia (pain under the ball of the foot as weight shifts to the lesser toes), hammertoe deformities in the adjacent toes, and difficulty fitting into shoes.

Who Gets Bunions?

Bunions affect approximately 23% of adults aged 18 to 65 and over 35% of adults over 65. They are significantly more common in women, though they occur in men as well. The primary causes include genetics (foot structure is inherited), shoe wear (narrow, pointed, high-heeled shoes can accelerate progression), and underlying biomechanical factors such as flat feet, ligamentous laxity, and inflammatory conditions like rheumatoid arthritis.

When to Consider Bunion Surgery

You May Be a Candidate If:

• You have a bunion that causes persistent pain not relieved by shoe modifications, padding, orthotics, or anti-inflammatory medications
• The deformity is progressing — the angle of the big toe is increasing over time
• You have difficulty finding shoes that fit comfortably
• The bunion is interfering with your ability to walk, exercise, or stand for extended periods
• You have developed secondary deformities — hammertoes, crossover toes, metatarsalgia — caused by the altered biomechanics
• Your quality of life has materially declined because of the foot

When Conservative Care Is Appropriate

Not every bunion needs surgery. If your bunion is mild, minimally painful, and not limiting your activities, conservative management is reasonable. This includes wider shoes with a roomy toe box, bunion pads or sleeves, custom orthotics to address underlying biomechanics, anti-inflammatory medications for flares, and activity modification. Conservative treatment cannot correct the deformity, but it can manage symptoms effectively for many patients.

"I tell patients that bunion surgery is an elective quality-of-life decision — not an emergency," says Dr. David Lee, an orthopedic foot and ankle surgeon at Commons Clinic. "If the bunion is not limiting your life, we monitor it. If it is, we fix it. The timing is yours to decide."

Types of Bunion Surgery

The type of bunion surgery recommended depends on the severity of the deformity, the condition of the joint, and your specific anatomy. Modern bunion surgery aims to realign the bone, correct the underlying structural problem, and produce a result that lasts.

Osteotomy Procedures

An osteotomy involves cutting the first metatarsal bone and repositioning it to correct the alignment. This is the most common category of bunion surgery.

Chevron osteotomy. A V-shaped cut near the metatarsal head. Best for mild to moderate bunions. The metatarsal head is shifted laterally and fixed with a screw.

Scarf osteotomy. A Z-shaped cut along the metatarsal shaft that allows both lateral translation and rotational correction. Provides excellent correction for moderate bunions with versatile fixation options.

Lapidus procedure (first tarsometatarsal fusion). Addresses the deformity at its origin — the joint between the first metatarsal and the medial cuneiform bone. Rather than cutting the metatarsal shaft, the Lapidus procedure fuses this proximal joint, correcting the metatarsal's inward drift at its base. This is increasingly recognized as the most anatomically correct and durable correction for moderate to severe bunions, particularly in patients with hypermobility of the first ray.

Proximal metatarsal osteotomy. A cut near the base of the metatarsal. Used for severe deformities requiring large corrections. Often combined with a distal soft tissue procedure.

Minimally Invasive Bunion Surgery

Minimally invasive techniques use one or more small incisions (typically 3 to 5 millimeters each) and fluoroscopic guidance to perform the osteotomy and fixation through the skin (percutaneously). Advantages include less soft tissue disruption, reduced post-operative swelling, and potentially faster recovery. Minimally invasive bunion correction is most appropriate for mild to moderate deformities.

Joint Fusion (Arthrodesis)

For severe bunions with significant arthritis in the MTP joint — where the cartilage is destroyed and the joint itself is the primary source of pain — first MTP joint fusion permanently connects the big toe to the metatarsal in a functional position. This eliminates motion at the joint (and therefore eliminates the joint pain) while preserving the toe's ability to bear weight and push off during walking.

How Bunion Surgery Works

Before Surgery

Your surgeon obtains weight-bearing X-rays to measure the angles of the deformity and assess joint condition. The intermetatarsal angle (between the first and second metatarsals) and the hallux valgus angle (the angle of the big toe) determine the severity classification and guide the choice of procedure.

Pre-operative planning includes a discussion of the specific procedure recommended, the fixation method (screws, plates, or staples), weight-bearing protocols, and recovery expectations.

During Surgery

Bunion surgery is typically performed under regional anesthesia (an ankle block or popliteal nerve block) with or without sedation. General anesthesia is used when preferred by the patient or anesthesiologist.

The procedure takes 45 to 90 minutes depending on the technique and whether additional procedures (hammertoe correction, second metatarsal osteotomy) are performed simultaneously.

Your surgeon makes an incision along the inside of the foot at the MTP joint. The displaced metatarsal is cut (osteotomy), repositioned to correct the alignment, and secured with titanium screws or plates. Any bone spur is removed. The joint capsule and surrounding soft tissues are repaired to hold the correction. For Lapidus procedures, the first tarsometatarsal joint is fused with screws or a plate to provide permanent stability.

After Surgery

Most bunion surgeries are performed on an outpatient basis — you go home the same day from MOSI. You will be in a post-operative surgical shoe or boot. Weight-bearing protocols depend on the procedure:

Osteotomy procedures (chevron, scarf): Immediate weight-bearing in a surgical shoe. You can walk on your heel and the outside of your foot from day one.

Lapidus procedure: Weight-bearing in a boot typically begins at two to four weeks, with progression to full weight-bearing by six weeks as the fusion heals.

MTP fusion: Similar to Lapidus — protected weight-bearing progressing over six weeks.

Recovery Timeline

Day of surgery: Home the same day from MOSI. Foot elevated and iced. Nerve block provides pain control for 12 to 24 hours. Surgical shoe or boot applied.

Week 1 to 2: Foot remains elevated as much as possible to control swelling. Walking is limited to essential trips (bathroom, kitchen). Sutures are typically removed at two weeks.

Week 2 to 6: Progressive increase in walking. For osteotomy patients, transition from surgical shoe to supportive sneaker typically occurs at four to six weeks. For Lapidus patients, transition from non-weight-bearing to weight-bearing in a boot occurs during this period.

Week 6 to 8: Return to regular footwear for most osteotomy patients. X-rays confirm healing. Driving resumes (timing depends on which foot was operated on — right foot surgery delays driving longer than left foot surgery in an automatic vehicle).

Month 2 to 3: Return to most daily activities. Walking distance increases. Low-impact exercise resumes — stationary cycling, swimming.

Month 3 to 6: Progressive return to full activity. Running and higher-impact activities are cleared individually. Residual swelling may persist for three to six months (this is normal and does not indicate a problem).

Month 6 to 12: Full recovery. Final shoe sizing may change — many patients find they can wear shoes they couldn't fit into for years. The forefoot achieves its final shape.

Benefits and Risks

Benefits

Modern bunion surgery provides reliable correction of the deformity, significant pain relief, and improved function for the majority of patients. Published data shows patient satisfaction rates of 85% to 95% for appropriately selected candidates. Correction of the bunion also addresses secondary problems — hammertoes, metatarsalgia, and difficulty with shoe fit — improving overall forefoot function.

Risks

Risks include recurrence of the deformity (5% to 15% depending on the procedure and the underlying cause), stiffness of the MTP joint, infection (1% to 2%), nerve irritation or numbness along the incision, hardware irritation (screws or plates that cause discomfort and may need removal in 5% to 10% of cases), delayed healing or nonunion (particularly in smokers and patients with diabetes), and overcorrection (hallux varus — the big toe angling too far the other direction). Your surgeon will discuss your specific risk profile.

Why Patients Choose Commons Clinic for Bunion Surgery

Dr. David Lee, MD is an orthopedic foot and ankle surgeon at Commons Clinic specializing in bunion correction, forefoot reconstruction, sports injuries of the foot and ankle, and fracture care. Dr. Lee's approach emphasizes selecting the procedure that provides the most durable correction for each patient's specific deformity — whether that's a minimally invasive osteotomy for a mild bunion or a Lapidus procedure for a severe deformity with first-ray hypermobility.

What sets Commons Clinic apart:

• Full range of bunion correction techniques. From minimally invasive percutaneous osteotomies to Lapidus fusion, the procedure is matched to the deformity — not the other way around.
• Same-day outpatient surgery at MOSI. Marina Orthopedic and Spine Institute is a fully accredited ambulatory surgery center designed for orthopedic procedures — not a hospital operating room.
• Extended consultation time. Nearly three times the national average ensures your deformity is thoroughly evaluated and your questions are answered.
• Vertically integrated care. Imaging, surgery, physical therapy, and pain management under one roof.
• Care Guarantee. A two-year warranty covering the full cost of professional follow-up care.
• Virtual consultations nationwide. Initial consultations and second opinions via telehealth for patients outside Los Angeles.

Frequently Asked Questions

How long does bunion surgery take?

The procedure typically takes 45 to 90 minutes, depending on the technique and whether additional procedures are performed. Including pre-operative preparation and recovery, plan for approximately three to five hours at the surgery center.

Can I walk after bunion surgery?

Yes — most patients walk in a surgical shoe or boot the same day. The degree of weight-bearing depends on the procedure. Osteotomy patients typically bear weight immediately in a surgical shoe. Lapidus and fusion patients may have a period of limited weight-bearing before progressing.

How long until I can wear normal shoes?

Most patients transition to supportive sneakers at four to six weeks and to dress shoes at eight to twelve weeks. Residual swelling can affect shoe fit for three to six months. Many patients ultimately find they can wear shoes that were too painful to consider before surgery.

Will the bunion come back?

Recurrence rates depend on the procedure, the severity of the original deformity, and underlying biomechanical factors. Reported recurrence rates range from 5% to 15%. Procedures that address the deformity at its structural origin (such as the Lapidus procedure) generally have lower recurrence rates than those that correct only the distal metatarsal.

Is bunion surgery covered by insurance?

Yes, when performed for a symptomatic deformity that has failed conservative treatment. Bunion surgery is covered by all major insurance carriers. Commons Clinic accepts Aetna, Cigna, Anthem Blue Cross, Blue Shield of California, and United Healthcare. Patients covered by Carrum, Transcarent, or LanternCare may qualify for $0 out-of-pocket cost.

Can both feet be done at the same time?

Bilateral bunion surgery (both feet at once) is possible and is performed for some patients. However, most surgeons recommend staging the procedures four to six weeks apart to allow one foot to recover enough to bear weight while the other heals. Your surgeon will discuss the best approach for your situation.

Key Takeaways

• Bunions are progressive structural deformities of the first ray — they do not correct on their own and tend to worsen over time
• Modern bunion surgery corrects the underlying bone alignment, not just the bump, providing durable results
• Procedure selection (osteotomy, Lapidus, minimally invasive, fusion) depends on the severity of the deformity and the patient's anatomy
• Most patients go home the same day and are walking in a surgical shoe or boot immediately
• Full recovery takes three to six months, with most patients returning to regular shoes by six to eight weeks
• Patient satisfaction rates of 85% to 95% for appropriately selected surgical candidates

Take the Next Step

If a bunion is limiting your ability to walk comfortably, exercise, or wear the shoes you want to wear, a consultation with an orthopedic foot and ankle surgeon is the best next step.

Dr. David Lee and the Commons Clinic foot and ankle team see patients at clinics across Los Angeles — including Santa Monica, Marina del Rey, Beverly Hills, and Long Beach — and perform surgery at MOSI in Marina del Rey.

Not in Los Angeles? Commons Clinic's virtual specialty clinic offers initial consultations and second opinions nationwide via telehealth.

Insurance: Commons Clinic accepts Aetna, Cigna, Anthem Blue Cross, Blue Shield of California, and United Healthcare. Patients covered by Carrum, Transcarent, or LanternCare may qualify for $0 out-of-pocket treatment.

Schedule a consultation: Call (310) 437-7921 or email hello@commonsclinic.com

Sources: Foot and Ankle International, Journal of Bone and Joint Surgery, The Journal of Foot and Ankle Surgery, American Orthopaedic Foot and Ankle Society, American Academy of Orthopaedic Surgeons