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By Richard Moy
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Bunions are far more than a cosmetic concern. A systematic review of 78 studies involving nearly 497,000 participants estimated that hallux valgus, the deformity commonly known as a bunion, affects 23 percent of adults aged 18 to 65 and 35.7 percent of adults over 65.
Meanwhile, a 2024 systematic review and meta-analysis examined more than 100 surgical techniques for correcting the condition, finding that the most appropriate approach remains debated.
Long-term results also warrant scrutiny: a separate 2024 review of five studies examining Scarf osteotomies (a surgical procedure to correct severe bunions) reported recurrence rates of up to 40 percent after at least eight years of follow-up, using a threshold of a hallux valgus angle greater than 15 degrees.
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These findings highlight a critical question for patients: Are they choosing a surgical procedure based on reliable evidence of lasting results, or on how convincingly it is marketed?
Searching For Options Can Be Confusing
When patients search online for bunion surgery, they are often presented with what appears to be a choice among modern, branded procedures. The names sound advanced. The animations are polished. The language suggests that newer technology must mean a better operation and an easier recovery.
But that may not be a real choice at all. Patients are often comparing marketing campaigns, not comparable evidence about what they will actually experience.
When I began my surgical career more than 35 years ago, there were already well over 100 described operations for correcting a bunion. A 2024 living systematic review and meta-analysis confirms that more than 100 surgical techniques have been described. Why are there so many procedures for one deformity?
In my view, the challenge has been finding a bunion procedure that consistently delivers lasting correction, manageable postoperative pain, early mobility, and a return to normal activities without significant complications.
That remains the central problem today. Yet the conversation has increasingly shifted away from the complete patient experience and toward the name of the operation, the device being used, and the novelty of the technology.
Surgery Is Not a Consumer Product
Bunion surgery is not a consumer product. It should not be evaluated like the newest phone or automobile, where the latest model is assumed to be an improvement. A new surgical system may offer a different way to cut, align, or stabilize bone, but “different” does not necessarily mean less traumatic, less painful, or more successful for the patient.
The evidence reinforces the need for caution. A 2024 Cochrane review of surgical interventions for bunions found that surgery may meaningfully reduce pain compared with no treatment or nonsurgical treatment, but the reviewers were uncertain about its effects on reoperation and adverse events.
The findings do not mean that surgery is ineffective. They underscore why claims about individual procedures should be supported by evidence addressing the outcomes patients care about.
Device manufacturers and procedure developers have a financial interest in promoting their technologies. Surgeons may be trained in those systems, and patients repeatedly encounter the same terminology online. Visibility creates familiarity, which can easily be mistaken for proof.
The most heavily marketed procedure, however, is not automatically the most effective one. Marketing can tell patients what a procedure is designed to accomplish. It cannot, by itself, tell them what hundreds of patients treated by a particular surgeon actually experienced.
Results and Procedures Can Vary
This distinction is crucial because an operation is not independent of the person performing it. Ten surgeons can perform what is called the same procedure and produce ten different sets of results.
Technical judgment, tissue handling, anesthesia, fixation, dressing technique, and postoperative care all influence the outcome. Patients therefore should not ask only, “Which procedure do you perform?” They should also ask, “What results do you repeatedly produce?”
My approach to bunion surgery dates to 1992 and has evolved through clinical practice. One component is a soft-tissue balancing technique I call the corset closure, intended to help maintain correction without routinely fusing the joint at the base of the first metatarsal.
The procedure also involves decisions about surgical technique, anesthesia, dressing, and postoperative care. These elements should be considered together when evaluating recovery and long-term outcomes. Documenting the approach in a surgical textbook provides an opportunity to describe its principles, applications, and limitations in a way that allows for critical assessment.
Patients Need To Consider Desired Outcomes
My argument is not that every patient should undergo my exact operation. It is that every bunion operation should be judged by the outcomes that matter to patients: How much pain did they experience? Did they need narcotics? When could they bear weight, return to shoes, work, drive, and exercise? Was the correction maintained? Did stiffness, nerve symptoms, hardware problems, or other lasting effects remain?
And, most importantly, are those results consistently reproducible in the hands of the surgeon whom the patient is considering?
Patient recovery should be assessed through clear, consistent measures of pain, mobility, return to daily activities, and long-term correction. These outcomes offer a more meaningful basis for evaluating bunion surgery than the name of a procedure or the technology used to perform it. The priority should be understanding what patients experience throughout recovery, rather than relying on how a procedure is presented in its marketing.
The importance of measuring outcomes directly is recognized beyond foot surgery. The U.S. Food and Drug Administration's guidance on patient-reported outcomes explains how reports from patients can capture symptoms, health status, and the effects of treatment on daily functioning.
For bunion surgery, that means evaluating not only radiographic correction but also pain, mobility, recovery time, and the patient's ability to return to everyday activities.
Patients considering bunion surgery should look past generic hospital brochures and advocate for their own recovery through rigorous, direct questioning of the surgeon. Before agreeing to go under the knife, demand transparency regarding their specific track record: Ask exactly how many years they have performed this precise technique, how many cases they have personally completed, and if you can see their consistently collected tracking data rather than pristine, published industry averages.
Force a candid conversation about the postoperative reality by asking what pain level you should realistically expect, how long it will last, and how often their patients require prescription opioids.
Your timeline for independence shouldn’t be a guessing game.
So secure explicit milestones for when you can safely walk, return to work, drive, exercise, and transition back into normal shoes. Finally, protect yourself against long-term complications by probing their personal rates of recurrence, joint stiffness, hardware removal, and reoperation, and cap off your vetting process by asking to speak with several of their former patients about recovery, including someone who is at least a year post-op.
Ideally, bunion surgery would have standardized patient-reporting measures for meaningful surgeon-to-surgeon comparisons. The same questions would be asked at the same postoperative intervals, without selectively displaying favorable outcomes. Patients could compare consecutive patients treated by one surgeon, not isolated success stories involving different surgeons and definitions of recovery.
This issue extends far beyond foot surgery. Patients increasingly enter healthcare through advertising, search algorithms, and social media. The treatment they see most often may simply be the treatment with the greatest marketing reach. The future of bunion surgery should not be determined by who markets a procedure the loudest. It should be determined by which surgeon and which approach repeatedly provide lasting correction, minimal unnecessary trauma, a manageable recovery, and restored function.
Patients do not need the best-known brand. They need the clearest evidence of what their own lives may look like after surgery.
Dr. Richard Moy, DPM, is a Southern California foot and ankle surgeon who developed his approach to virtually painless bunion correction in 1992. All opinions are the author’s own.
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