Bunions
Bunions are one of my favorite conditions to treat — not because they are simple, but because when treated properly, the results can be life-changing.
A bunion is a slowly progressive deformity of the big toe joint. Much like vision changes over time, bunions develop gradually. Early on, they may not cause pain. Over time, they can lead to instability, inflammation, and difficulty walking. A bunion is not just a “bump.” It is a structural misalignment of the first metatarsal and big toe.
CAUSES
What Causes Bunions?
Bunions develop due to a combination of:
Genetics (foot structure and inherited mechanics)
Environmental factors (shoe wear over time)
Biomechanical instability
As the deformity progresses:
The first metatarsal drifts inward
The big toe shifts outward
Joint instability increases
Cartilage may begin to deteriorate
This is a mechanical failure, not simply inflammation.
DIAGNOSIS
When is a Bunion a Problem?
Many bunions are painless for years. Surgery is not recommended simply because a bump exists. If bunion pain begins to affect your quality of life, then surgical correction may be appropriate. This may be the case, if you:
Cannot comfortably go for a walk
Avoid activities you once enjoyed
Shoes no longer fit properly
The deformity continues to progress
Our goal is always to meet you before it reaches that point, so we can stabilize the foot and potentially avoid surgery.
TREATMENT
Bunions
Conservative Treatment
Early treatment may include:
Activity modification
While conservative care will not reverse a bunion, it can slow progression and reduce symptoms. Much like glasses can slow progression of deteriorating vision, but not reverse it.
Bunion Surgery
There are over 60 described bunion procedures. The key is not choosing a popular procedure, it is choosing the correct procedure for you.
It is imperative to identify the center of rotational angulation (CORA) — the true apex of the deformity. This determines:
Where correction should occur
Which osteotomy or procedure is appropriate
How to restore alignment biomechanically
Every bunion is different. Surgical planning must be based on:
Your specific foot structure
The severity of deformity
Joint condition
Your lifestyle and activity goals
When done correctly, bunion surgery restores alignment, stability, and function — not just appearance.
Choose Your Surgeon Carefully
Bunion surgery is highly technical, and procedure selection matters! We always encourage second opinions. You should feel confident that:
Your deformity has been fully evaluated
The correction matches your biomechanics
The surgical plan is tailored to your life
As a reconstructive foot and ankle surgeon serving New England, my focus is restoring structural balance and long-term function, not just removing a bump.
Don’t Wait Until Your Life is Limited
If your bunion pain is:
Progressively worsening
Limiting walking or exercise
Changing the shape of your foot
You deserve a comprehensive evaluation — the sooner, the better.
The earlier we intervene, the more options you have, because the longer instability progresses, the more complex correction becomes.
“
Dr. Stark was amazing. She gave me some alternative solutions to get me by until I decided to have surgery, but explained, using my X-rays, that surgery was inevitable.
The X-rays said it all. I was so happy I finally went to see a doctor and I highly recommend them.
— ANNE
Scientific Research
This article describes hallux valgus (bunions) as a lateral deviation of the big toe that commonly causes pain and difficulty with footwear. It explains that the condition has both intrinsic (anatomy, genetics) and extrinsic factors, with tight or narrow shoes acting as a major contributing factor. Management typically begins with conservative measures such as footwear modification, with surgery considered for persistent symptoms or significant deformity.
This randomized controlled trial compared minimally invasive bunion surgery (MITO technique) with traditional open surgery and found similar improvements in alignment and functional outcomes at one year. MIS patients demonstrated better early wound healing and recovery, with comparable complication rates between groups. The study suggests MIS provides short-term advantages while maintaining similar overall effectiveness.
Lapidus Arthrodesis for Correction of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis
This systematic review and meta-analysis evaluated different fixation methods used in the Lapidus procedure for bunion correction and found that all techniques achieved similar deformity correction and functional outcomes. However, complication rates varied, with plantar plating showing the lowest rates of nonunion, hardware removal, and overall complications compared to screw-only or dorsomedial plating methods. The study suggests that outcomes in Lapidus surgery are strongly influenced by fixation technique, with newer methods potentially allowing earlier weight-bearing and improved recovery.
