Hallux valgus
Hallux valgus, commonly known as a bunion, is a progressive condition where the big toe drifts toward the smaller toes. This shift causes a noticeable bump on the inside edge of the foot at the base of the big toe. The deformity results from changes in bone alignment and soft tissue balance in the front of the foot. Over time, it can cause pain, swelling, difficulty wearing shoes, and cosmetic concerns.
How Common It Is and Who Gets It? (Epidemiology)
Bunions are very common in adults and occur more frequently in women than in men. Familial clustering is common, meaning that genetics plays a role. Though they can develop in children and teenagers, they are far more frequent in adults. Ballet dancers and people who wear tight or high-heeled shoes are at higher risk.
Why It Happens – Causes (Etiology and Pathophysiology)
Hallux valgus develops from both intrinsic and extrinsic causes.
Intrinsic factors include genetic predisposition, looseness of the joint at the base of the big toe, a rounded or convex shape of the metatarsal head, flatfoot, and connective tissue laxity. Inflammatory conditions such as rheumatoid arthritis can also contribute.
Extrinsic factors include wearing high heels or narrow shoes that squeeze the toes together.
As the deformity progresses, the first metatarsal bone drifts inward while the big toe drifts outward. The tendons and ligaments around the joint become imbalanced, worsening the deformity and sometimes leading to pain in the ball of the foot (transfer metatarsalgia).
How the Body Part Normally Works (Relevant Anatomy)
The big toe and its supporting structures, known as the first ray, play a key role in balance and walking. Important components include the first metatarsal bone, the sesamoid bones beneath it, and the adductor and abductor hallucis tendons that stabilize the toe. Ligaments and the joint capsule hold the toe in alignment. When these tissues become imbalanced, the toe begins to drift outward, forming a bunion.
What You Might Feel – Symptoms (Clinical Presentation)
Patients often notice a bump on the inside of the foot near the big toe joint. Pain, swelling, redness, and difficulty wearing shoes are common. Some people feel burning or aching pain, especially after standing for long periods. In more advanced cases, the big toe may overlap the second toe, causing calluses or secondary toe deformities. Many patients also report cosmetic concerns or limited movement of the big toe.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis starts with a detailed history and physical exam. The doctor will ask about symptoms, footwear habits, and how long the problem has been present.
During the exam, they assess toe alignment, flexibility, and signs of inflammation.
Imaging: Weight-bearing X-rays are used to confirm the diagnosis and determine the severity of the deformity. Key measurements include the hallux valgus angle (the angle between the big toe and the first metatarsal) and the intermetatarsal angle (between the first and second metatarsals). X-rays also help plan surgery when needed.
Classification
Bunions are classified as mild, moderate, or severe based on the measured angles on X-rays. The position of the sesamoid bones beneath the joint also helps grade severity. These classifications guide treatment planning and surgical technique selection.
Other Problems That Can Feel Similar (Differential Diagnosis)
Several other conditions may mimic bunion symptoms, including:
- Hallux rigidus: Arthritis and stiffness of the big toe joint.
- Hallux varus: Overcorrection of a previous bunion surgery.
- Gouty bunion: Inflammation caused by uric acid crystal buildup.
- Inflammatory bunion: Seen in conditions like rheumatoid arthritis.
Treatment Options
Non-Surgical Care
Most patients begin with conservative treatment.
- Wearing wide, comfortable shoes with a low heel can relieve pressure.
- Using toe spacers, pads, or orthotic inserts may reduce pain but do not correct the deformity.
- Stretching and physical therapy can improve flexibility.
- Pain medication or injections may reduce inflammation.
These measures can improve comfort but will not reverse the alignment changes.
Surgical Care
Surgery is considered when pain persists despite conservative care or when the bunion significantly interferes with daily life.
Procedures are chosen based on the deformity’s severity and joint flexibility:
- Distal metatarsal osteotomy (cutting and realigning the bone) for mild deformities.
- Proximal osteotomy or combined procedures for larger deformities.
- First tarsometatarsal fusion (Lapidus procedure) for severe cases or joint instability.
Soft tissue procedures such as lateral release and medial capsule tightening are often performed in combination.
For young patients, non-surgical care is preferred until growth is complete, as early surgery may increase the risk of recurrence.
Recovery and What to Expect After Treatment
After surgery, patients typically wear a protective shoe or boot for several weeks. Weight-bearing is usually limited initially and then gradually increased. Physical therapy helps restore motion, strength, and gait. Most people return to normal shoes within 6–12 weeks, though complete recovery can take several months. Mild swelling may persist for up to a year.
Possible Risks or Side Effects (Complications)
Possible complications include recurrence of the bunion, overcorrection into a hallux varus deformity (where the toe turns inward), nerve irritation, stiffness, or pain under the smaller toes. In rare cases, bone healing problems or infection can occur.
Long-Term Outlook (Prognosis)
When the correct procedure is matched to the severity of the deformity, patients typically enjoy good pain relief and improved function. However, recurrence can occur if the underlying biomechanical issues, such as flatfoot or joint instability, are not addressed.
Out-of-Pocket Costs
Medicare
CPT Code 28296 – Bunionectomy with Osteotomy
Estimated Out-of-Pocket Cost: $157.25
Under Medicare Part B, about 80% of the approved amount is covered after the deductible. Supplemental or Medigap insurance usually covers the remaining 20%, leaving little to no cost for patients. Secondary coverage like TRICARE or employer health plans may also fill in gaps.
Workers’ Compensation
Workers’ compensation typically covers both non-surgical and surgical care if the bunion developed or worsened due to workplace activity or footwear requirements. There are no out-of-pocket costs for authorized treatment.
No-Fault Insurance
If the bunion resulted from a car accident, no-fault insurance may pay for evaluation, therapy, and surgery when medically necessary. Coverage limits depend on the policy.
Example:
A patient with Medicare and a Medigap plan who undergoes CPT 28296 bunion surgery at an ambulatory center may pay $0–$50 total, depending on copays and facility fees.
Frequently Asked Questions (FAQ)
Is a bunion just a bump?
No. A bunion is a deformity involving bone and soft tissue misalignment, not just a bump.
Can bunions go away without surgery?
No, conservative treatments help relieve pain but do not reverse the deformity.
When should I consider surgery?
If pain interferes with walking or shoe wear despite non-surgical care, surgery may be considered.
Can the bunion come back after surgery?
Yes, recurrence is possible, especially if joint instability or flatfoot is not addressed.
Summary and Takeaway
Hallux valgus, or bunion, is a common and progressive deformity that can cause pain, difficulty wearing shoes, and functional problems. Early treatment focuses on comfort and slowing progression. Surgical options can correct alignment and relieve pain when conservative care no longer helps. With appropriate treatment and footwear, most patients regain comfort and function.
Clinical Insight & Recent Findings
A 2024 systematic review by Khan and Patil evaluated various therapeutic approaches for hallux valgus and found that both conservative and surgical treatments can improve symptoms, but their goals differ.
Nonsurgical methods—such as soft tissue mobilization, stretching, kinesiology taping, and foot-strengthening exercises—help reduce pain, improve mobility, and enhance gait, though they do not permanently correct the deformity.
Surgical procedures, including osteotomies and soft tissue balancing techniques, remain the mainstay for moderate to severe cases, offering better long-term correction when followed by structured physiotherapy. Postoperative rehabilitation emphasizing range of motion, muscle strengthening, and gait retraining is critical to restoring proper function and minimizing recurrence. (“Study on physical therapy and surgical outcomes for bunions – see PubMed.”)
Who Performs This Treatment? (Specialists and Team Involved)
Bunion treatment is managed by an orthopedic foot and ankle surgeon or podiatric surgeon. The care team often includes an anesthesiologist, nurse, and physical therapist who help manage surgery, recovery, and rehabilitation.
When to See a Specialist?
You should see a specialist if you have persistent foot pain, visible deformity, difficulty finding comfortable shoes, or symptoms that interfere with daily activities. Early evaluation can prevent progression and help determine the best treatment plan.
When to Go to the Emergency Room?
Seek emergency care if you have sudden, severe foot pain, inability to bear weight, visible deformity after trauma, or signs of infection such as redness, warmth, or drainage—especially if you have diabetes.
What Recovery Really Looks Like?
Recovery can involve several weeks of limited activity and footwear restrictions. Swelling and stiffness are normal early on but gradually improve. Physical therapy and supportive shoes help restore mobility and prevent recurrence.
What Happens If You Ignore It?
If untreated, bunions can worsen over time, leading to chronic pain, overlapping toes, calluses, and difficulty walking. Severe deformities may require more complex surgeries and longer recovery times.
How to Prevent It?
Choose shoes with a wide toe box, low heel, and good arch support. Stretch your feet regularly, strengthen foot muscles, and avoid shoes that squeeze the toes. Early management of flatfoot or joint laxity can reduce risk.
Nutrition and Bone or Joint Health
A diet rich in calcium, vitamin D, and protein supports bone strength and healing. Staying hydrated and maintaining a healthy weight can reduce stress on the feet and joints.
Activity and Lifestyle Modifications
After treatment, patients are encouraged to return gradually to normal activity. Low-impact exercises such as walking, cycling, and swimming are safe. Avoid tight shoes and high heels, and maintain proper foot alignment through supportive footwear and regular stretching.
Do you have more questions?
What is a Bunion? What is Hallux Valgus?
A bunion is a bony bump that forms on the joint at the base of the big toe. It occurs when the big toe pushes against the next toe, forcing the joint of the big toe to get larger and stick out. This
condition is often associated with the misalignment of the bones in the foot, leading to the formation of the bunion.
This is also called hallux valgus deformity. Over time the metatarsal head (bony bump) will tend to drift and become more prominent.
What do patients with a Bunion feel?
Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will also tend to have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.
What are the symptoms of a bunion?
Symptoms of bunions may include pain, swelling, redness, and restricted movement of the big toe. In some cases, bunions may not cause any discomfort, but they can still affect the alignment
of the toes and the overall structure of the foot.
Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will tend to also have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.
What causes a bunion?
Bunions can be caused by various factors, including genetics, improper footwear, and certain foot conditions. High-heeled shoes and narrow-toed shoes can contribute to the development or worsening of bunions by squeezing the toes together. The pressure on the joint can lead to inflammation, pain, and the characteristic bony bump.
How do you diagnose a bunion / Hallux valgus?
Most bunion are diagnosed on clinical examination and X-rays.
What criteria is used to diagnose hallux valgus (Bunion)?
Your foot has a normal amount of outward angulation at the big toes joint. Less than 15 degrees is considered normal. This is called a Hallux Valgus Angle. 15-30 degrees is considered moderate deformity. More than 30 degrees is considered severe deformity. More than 40 degrees is considered a very severe deformity.
We also use a measurement called a intermetatarsal angle. This is also elevated in hallux valgus deformity. Normally it is less than 9 degrees, but it can be elevated in hallux valgus. Treatment options change depending on the severity of your deformity.
What are treatment options for a bunion? Is there any treatment for bunions?
Treatment options for a bunions / Hallux Valgus include operative and non operative options. The goal of treatment is to reduce pain, increase mobility, and restore function. We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a difference. This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing. There are low profile braces that can help correct the position of the toes.
These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.
What are non-operative treatments for a bunion? What is the treatment for bunions without surgery?
We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a
difference.
This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing.
There are low profile braces that can help correct the position of the toes. These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.
Do non-surgical bunion treatments work?
In most cases of hallux valgus / bunions the deformity tends to get worse and worse. This will likely happen over years. As this occurs, your pain will tend to be more frequent and more severe.
Non-operative treatment can help in less severe cases of hallux valgus. As the deformity worsens, as symptoms progress, non-operative measures are more likely to fail. Surgery is more likely indicated in severe cases.
What is Lapiplasty Bunion Surgery?
Lapiplasty is a type of bunion correction surgery. It an exciting new type of bunion correction that utilizes special guides / jigs to re-align the foot. It is combined with release of tight soft tissue structures and tightening of lax soft tissue structures. In doing this it corrects the bunion deformity.
How does Lapiplasty work?
The bunion is caused by a rotation and abduction deformity at the tarsometatarsal joint. We make and incision here, release the joint, and make bony cuts to allow the deformity to be corrected.
We then apply places to hold it in this position, while the joint fuses. The corrects the deformity. We then make incision around the bunion to release the tight structures in between the 1 st and 2 nd toes. This can usually be done with a small incision and a releasing device. In some cases we have to make an incision over the bunion, remove excess bone, and tighten the soft tissue (capsule) on this side to correct the deformity further.
Occasionally, in severe deformity, we have to make a bony cut in the proximal phalanx as well. This is usually fixed with a screw.
What to expect after Lapiplasty surgery? How long is recovery after Lapiplasty?
The surgery itself typically takes 1-2h and can be done as an outpatient procedure. You go home the same day in most cases.
Following surgery, you will have a dressing on your incision and a cast on your foot. Ideally the area should remain completely dry until the staples / sutures are removed (2-3 weeks after surgery). We see you at 2 weeks after surgery to remove sutures and change the cast. You will go into a pneumatic walking boot at 2 weeks after surgery.
We allow the bones to heal partially before you start weight bear. This means you start walking / weight bearing in a walking boot at 4 weeks post surgery. Physical therapy typically starts
around this time as well.
Surgery is painful. Most of the pain is experienced in the first few days. We give you strong pain medication and a pain management plan to address this. Swelling management is paramount.
The foot will swell greatly after foot surgery. Icing and elevation are imperative. After the firstweek the pain tends to improve rapidly. I anticipate at two weeks post surgery the pain is much better. At 6 weeks most the pain should be gone.
Swelling may be present for 6+ months after surgery. Eventually this returns to normal levels. This is the case for all foot surgery.
Most patients are relatively pain free and have near full function of the foot around 2-3months after Lapiplasty.
Does Lapiplasty work?
Many studies have shown that Lapiplasty reliably corrects the deformity that cause bunion related pain. Furthermore, early results suggest that patient have excellent reduction of pain and are able to mobilize sooner than other methods of bunion correction.
Who is not a candidate for Lapiplasty?
Patient who would not be a good candidate for Lapiplasty are the same patient who are not good candidates for foot surgery. This includes patients with vascular disease of the lower limb, diabetes, end stage renal failure, smokers, and patient with a history of poor wound healing.
The surgery would also be inappropriate in those patients who already have arthritis of the 1 st MTP joint (Bunion joint). Other foot deformities may preclude us from doing this surgery as
well.
Are you put to sleep for Lapiplasty bunion surgery?
Typically, yes. Most of the time this surgery is done under a general anesthetic. Often it will be combining with peripheral nerve blocks for pain control.
Is Lapiplasty surgery painful?
It is as painful as most foot surgeries. However, we do our best to control your acute pain. This is done though nerve blocks, local anesthetic, and pain medication. Typically, after the 1-2 weeks,
the pain is very manageable. The first few days are typically the worse. Most patients require opioid medication during this time. However, after that, most patients are able to cope with Acetaminophen and an anti-inflammatory.
How long does Lapiplasty bunion surgery take?
1-2 hours
What is the difference between Lapiplasty and regular bunion surgery?
Lapiplasty differed in the sense that the procedure is systematic. The guides and jigs used to correct deformity work well for all patients, all deformities, and all shapes of foot. They allow for reliable fixation. There is less guess work and more accuracy compared to traditional bunion surgery. It is success is quickly allowing it to become the most commonly performed bunion surgery in recent years.
Can bunions come back after Lapiplasty?
Bunions can recur after any surgery. However, this is usually because bunion correction is done at a young age. The younger you are, the more likely it will recur. Lapiplasty is a relatively new
procedure, and the long-term recurrence rates are not known. However, recurrence rates for Lapidus procedures (on which the Lapiplasty is based) are very low.
Can Lapiplasty correct hammer toes?
Typically, no.
Can I wear heels after Lapiplasty?
Once you are fully recovered, yes.
Can you run after Lapiplasty?
Once you are fully recovered, yes.
How long after Lapiplasty can I drive? When can I drive after Lapiplasty?
Typically, you can start driving once the walking boot is discontinued. This is usually approximately 6 weeks after surgery
How long after Lapiplasty walk I drive? When can I walk after Lapiplasty?
Typically, patients are started walking / weight bearing approximately 4 weeks after surgery.
How long are you in a boot with Lapiplasty?
4-8 weeks
Is Lapiplasty covered by insurance?
Yes
Is Lapiplasty covered by Medicare?
Yes.
How much does Lapiplasty cost?
This varies from person to person depending on the insurance plan. We are happy to work with all insurance and figure out a solution to allow us to do this for you.
Our billing agents are very helpful in this regard. Please feel free to have a conversation with one of them.
Who does Lapiplasty near me?
We can do the Lapiplasty procedure for you. Our foot and ankle specialist is well-versed in this procedure.
Dr. Mo Athar
