Thumbs Up or Down for Mini-Bunion Surgery?

Q: My little bunion doesn’t really bother me—but should I have it surgically fixed to keep it from getting worse?

A: Probably not. A bunion—which is an enlargement of the bone or swelling of tissue around the joint at the base of the big toe—often is caused by faulty foot mechanics, meaning that the foot rolls in too much when you walk. Bunion surgery generally is appropriate only if the bunion is painful… or there is limitation in the range of motion… or the big toe is drifting toward the second toe. The so-called mini-bunionectomy—surgical correction of a mild and painless bunion using a small incision—is rarely necessary or advisable given that surgery carries some risk for infection, nerve damage or other complications. What’s more, because such surgery does not address the underlying cause of the problem, the bunion would probably just come back anyway.

The best way to keep a mild bunion from progressing to the point where surgery is needed is to correct the faulty foot mechanics that caused the bunion to form in the first place. Your podiatrist can help you learn how to walk properly so your foot does not roll inward. He or she also can prescribe custom-made orthotic inserts for your shoes to help keep your foot in the correct position. High-heeled, pointy-toed shoes can definitely make a bunion worse, so it is a good idea to stick with shoes that have a low heel (no higher than 1½ inches), wide toe box and adequate arch support.

Referral to a podiatrist: American Podiatric Medical Association, www.apma.org.