A bunion is a structural deformity of the foot where the bone behind the big toe, the first metatarsal, shifts outward, causing the big toe itself to angle inward toward the smaller toes. This misalignment creates a prominent, painful bony bump on the side of the foot, medically known as hallux valgus. When conservative treatments like orthotics and wider shoes fail to alleviate chronic pain, a surgical procedure called a bunionectomy may be necessary. Selecting a surgeon for this intricate bone and joint correction requires careful consideration, as the field involves specialists with distinct training backgrounds.
The Primary Surgical Specialists
Bunion surgery is performed by two types of highly trained specialists: Podiatric Surgeons and Orthopedic Surgeons.
Podiatric Surgeons hold a Doctor of Podiatric Medicine (DPM) degree and focus their entire practice on the diagnosis, treatment, and surgery of the foot and ankle. Their four years of medical school and subsequent three or four-year residency are dedicated solely to the lower extremity, resulting in specialized knowledge of foot biomechanics.
Orthopedic Surgeons hold a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree and complete a five-year residency covering the entire musculoskeletal system. To specialize in bunion surgery, they must complete an additional one-year fellowship specifically in foot and ankle surgery. Both DPMs and MDs/DOs are fully qualified to perform bunionectomies, but their training pathways emphasize different scopes.
Podiatric Surgeons are typically board certified by the American Board of Foot and Ankle Surgery (ABFAS). Orthopedic Surgeons are certified by the American Board of Orthopaedic Surgery (ABOS). The bunionectomy procedure involves cutting and realigning the metatarsal bone, which both specialists are trained to execute.
The Role of Other Care Providers
Before reaching a surgical specialist, other medical professionals manage the diagnosis and conservative treatment of bunions.
The initial point of contact is often a Primary Care Physician (PCP), who performs a basic screening and recommends early non-surgical care. The PCP manages minor symptoms and provides a referral to a specialist if pain persists or the deformity progresses.
General Podiatrists, who may or may not focus on surgery, are the experts in conservative bunion treatment. Non-surgical methods cannot reverse the structural deformity, but they effectively manage symptoms and slow progression. These treatments include custom-molded orthotic devices, padding to reduce shoe irritation, and anti-inflammatory medications.
Surgery is typically recommended only after a lengthy trial of conservative care has failed to provide adequate pain relief. The general podiatrist determines when the condition requires surgical intervention, ensuring the patient has exhausted all less-invasive options.
Choosing the Right Surgeon
When the decision for surgery is made, the final choice should focus on the individual surgeon’s credentials and specific experience, rather than solely on their degree.
A surgeon’s board certification, such as by ABFAS or ABOS, confirms they have passed rigorous examinations and met high standards of training. Patients should verify that their surgeon maintains current board certification, which indicates an ongoing commitment to surgical standards.
Experience is an important factor, and patients should inquire about the surgeon’s specific volume of bunion correction procedures. A surgeon who performs a high number of bunionectomies, especially using the technique recommended for the patient’s condition, is preferable. Complex techniques, like a triplanar correction, require specialized expertise that comes with high case volume.
Patients should also confirm the surgeon has hospital privileges to perform the procedure in an accredited hospital or surgical center. This credentialing process ensures the surgeon is regularly evaluated and approved to perform complex bone and joint surgeries.