What's Actually Happening With Your Bunion
Your bunion isn't just a bump on the side of your foot. It's a three-dimensional deformity where your first metatarsal bone has shifted out of position. Think of it like the Leaning Tower of Pisa—except your "tower" isn't just leaning sideways, it's also rotating and lifting up. That's why simply shaving down the bump doesn't fix the real problem.
The real issue is an unstable joint in the middle of your foot called the first tarsometatarsal joint (TMT joint). When this foundation becomes unstable, it allows your metatarsal bone to drift, creating the bunion deformity you can see. Research shows that 87% of bunions involve bone misalignment in all three dimensions—sideways, rotationally, and vertically.<sup>1</sup>
What You Should Try Before Considering Surgery
Look, before we even discuss surgery, I need to make sure you've truly exhausted conservative treatment. Here's what I tell every patient: about 70% of my bunion patients never need surgery. That's not false hope—it's clinical reality based on 25 years of treating bunions in Houston.
A comprehensive conservative trial typically takes 4-6 months. That's not me telling you to suffer for half a year—that's the realistic timeframe to see if conservative care will be sufficient for your situation. You should notice some improvement within the first 6-8 weeks if it's going to work for you.
Proper Footwear
Your shoes need a wide, rounded toe box—not pointed, not even slightly tapered. The shoe should bend at the ball of your foot, not in the middle of the arch. Heel height under two inches, preferably flat. I often recommend brands like New Balance, Brooks, Clarks, Ecco, and Naturalizer because they tend to accommodate bunions better.
Custom Orthotics: Real Mechanical Correction
Think of custom orthotics like eyeglasses for your feet. While I'm wearing my glasses, I can see clearly. When I take them off, I can't. Orthotics work the same way—they compensate for your foot mechanics while you're wearing them. They don't "fix" the bunion, but they can significantly reduce pain and slow progression. About 60-70% of patients who commit to wearing properly fitted custom orthotics avoid surgery entirely.
What About Regenerative Medicine?
Now, you might be wondering about shockwave therapy or PRP. I'll be completely honest: these regenerative medicine treatments can't correct a bone deformity. When you have a misaligned bone, you can't inject it with growth factors and expect it to straighten. However, these treatments can be helpful for soft tissue inflammation around the bunion or early arthritis in the joint.
When Surgery Actually Makes Sense
I won't recommend surgery unless you meet specific criteria:
First: You've tried comprehensive conservative treatment for 4-6 months. This includes proper footwear, custom orthotics, padding, and activity modifications. You've given your body a real chance to respond to conservative care.
Second: Pain significantly limits your daily activities. You're avoiding walks you used to enjoy. You're planning your day around what shoes you can tolerate. You're limiting exercise or social activities because of foot pain.
Third: Progressive deformity is affecting adjacent toes. Sometimes a bunion creates a domino effect. Your big toe pushes into your second toe, which starts to develop a hammertoe deformity. When one problem is creating additional problems, that changes the equation.
Fourth: You're willing to commit to the recovery process. Surgery isn't a quick fix. Even with modern techniques, you're looking at several weeks of modified activity and months for complete recovery.
It's not about how your bunion looks—it's about whether it's keeping you from living your life.
And honestly? Only you can answer that question. My job is to give you the information you need to make the decision that's right for YOU.
If you're wondering whether you've reached the point where surgery makes sense, contact us for an evaluation. I'll give you an honest assessment—no pressure, no rush. Call my Houston office at 713-785-7881 or request an appointment online.
The 70% Problem: Why Traditional Bunion Surgery Often Fails
Here's what most doctors won't tell you: 70% of bunions come back after traditional surgery.<sup>2</sup> That's not 
a typo. Seven out of ten patients who have conventional bunion surgery will see their deformity gradually return over the following years.
Why does this happen? Because traditional bunion procedures don't address the root problem—that unstable foundation joint. Most surgeons make a cut in the bone near your toe, shift it over, shave down the bump, and secure everything with screws. The initial results look great. Your toe is straight, the bump is gone, you're thrilled.
But here's the thing. That foundation joint—the TMT joint in the middle of your foot—is still unstable. Nothing in the surgery stabilized it. So over time, the mechanical forces that created your bunion in the first place start working again. Slowly, gradually, your metatarsal bone begins to drift back out of position. Within 5-10 years, many patients are right back where they started.
This is why I've moved to modern techniques that actually stabilize the foundation joint and correct all three dimensions of the deformity. When you're going to have surgery—when you're committing to the recovery process and taking time away from your life—you deserve an approach that addresses the real problem, not just the symptom.
Houston Podiatrist's Approach: Lapiplasty 3D Bunion Correction
When surgery is necessary, technique matters. Here's what I use in my Houston practice, and why it's different from 
what you might be imagining when you think of bunion surgery.
Lapiplasty bunion surgery is a fundamentally different approach. Instead of just cutting and shifting the bone near your toe, we rotate your entire first metatarsal bone back to its anatomically correct position in all three planes—sideways, rotationally, and up-and-down. Then we stabilize that foundation joint (the TMT joint) with specialized titanium plates. We're not just straightening the tower—we're fixing the foundation so it can't lean again.
Recovery Comparison
Lapiplasty 3D Correction:
- Walking in surgical boot: Week 1
- Regular shoes: 6-8 weeks
- Return to work (desk job): 2-4 weeks
- Full recovery: 4-6 months
Traditional Surgery:
- Weight-bearing: 6-8 weeks (crutches/knee scooter)
- Regular shoes: 10-12 weeks
- Return to work (desk job): 8-12 weeks
- Full recovery: 6-12 months
Patient satisfaction with Lapiplasty is over 90%, with recurrence rates around 10%—dramatically different from that 70% recurrence with traditional techniques.<sup>3</sup>
Cost Transparency: What Bunion Surgery Actually Costs in Houston
Let's talk about cost, because this is often the elephant in the room that nobody wants to discuss. You deserve to know what you're looking at financially before making this decision.
Here in Houston, bunion surgery typically costs between $3,000 and $15,000 depending on several factors. That's a wide range, I know. Procedure complexity, facility fees (surgery center versus hospital), anesthesia type, and the hardware used all affect the final cost.
Most insurance plans cover bunion surgery when it's medically necessary. That means you've tried conservative treatment, the bunion causes significant pain or functional limitation, and surgery is recommended to restore function.
In my Houston podiatry practice, our team handles all the insurance pre-authorization work. We submit everything to your insurance company before we schedule surgery, so you know exactly what you'll pay out of pocket. No surprises when you get the bill weeks later.
Questions to Ask Your Surgeon
Before you schedule surgery with any doctor—including me—you deserve clear answers to these questions:
"What specific procedure are you recommending and why?" There are over 100 different bunion procedures. You need to know which one is being recommended for you specifically and why it's the best choice for your anatomy.
"Do you address the foundation joint (TMT joint) or just the bone near the toe?" This question determines your recurrence risk. Any bunion surgeon should be able to explain their approach to the foundation joint.
"What's your recurrence rate with this procedure?" Surgeons who track their outcomes should be able to give you general numbers. If they say "I've never had one come back" or "I don't know"—those are both red flags.
"How long will I be non-weight-bearing?" This dramatically impacts your life planning. You need specific information, not "it varies."
And look, these questions apply to me too. When you come in for a consultation, ask me these exact questions. I want you to feel confident in your decision, whether that's surgery with me, surgery with someone else, or no surgery at all.
Special Considerations
Diabetics: If you have diabetes, your A1C needs to be well-controlled before we can safely do elective foot surgery. High blood sugar impairs healing and dramatically increases infection risk. Learn more about diabetic foot care.
Revision Surgery: If you've had bunion surgery before and it failed, that's more complex. There's scar tissue to work through, and bone may be compromised from previous hardware. This is actually where Lapiplasty often shines because we can address that unstable foundation that the first surgery missed.
Both Feet: If you have bunions on both feet, we usually stage the surgeries—do one foot, let it recover, then do the other. You need at least one good foot to walk on during recovery.
Want to know for sure whether you're a candidate for bunion surgery? Come in for an evaluation and we'll figure out together what makes sense for your situation. No pressure, no rush—just honest guidance. Call my Houston office at 713-785-7881 or request an appointment online.
What to Expect When You Come In
When you come into my Houston office for a bunion evaluation, here's exactly what's going to happen. I'll start by 
listening. I want to hear about your pain—when it started, what makes it worse, what you've already tried. I'm going to ask about your activities and goals. What do you want to get back to doing?
Then I'll examine your foot and watch you walk to assess your gait. We'll take X-rays while you're standing—weight-bearing X-rays show me what your foot actually does when you're on it, which is very different from what it looks like when you're lying on an exam table.
Then we'll sit down and talk about what I found. I'll show you your X-rays and explain what's happening with your bunion. We'll discuss whether you've truly exhausted conservative care or if there are non-surgical options we haven't tried yet. If surgery makes sense, I'll explain which procedure I'd recommend for your specific anatomy and why.
Here's what I won't do: I won't pressure you. I won't schedule surgery that day unless you've already made your decision and you're ready. This is your decision, not mine.
So, Do You Need Bunion Surgery?
For about 70% of people, the answer is no—at least not right now. But if you meet the criteria we discussed—you've tried comprehensive conservative care, pain significantly limits your daily activities, or progressive deformity is affecting adjacent toes—then yes, surgery might genuinely give you your life back. The key is choosing a technique that addresses the root problem: that unstable foundation joint and three-dimensional deformity need to be corrected for lasting results.
I won't judge you whether you've been dealing with this for months or years. And you can choose to manage your bunion conservatively, or we can discuss surgical options. But either way, I need to see you to evaluate your specific situation and figure out what's right for you.
Don't wait until your bunion gets worse or starts affecting your other toes. Contact your Houston podiatrist Dr. Andrew Schneider for an immediate appointment at 713-785-7881 or request an appointment online. Even if you're not ready for surgery—and most people aren't—there are things we can do right now to get you more comfortable. The sooner we evaluate your bunion, the sooner we can create a plan based on YOUR goals and get you back to the activities you love.
References
- Dayton P, Kauwe M, Feilmeier M. Is our current paradigm for evaluation and management of the bunion deformity flawed? A discussion of procedure philosophy relative to anatomy. J Foot Ankle Surg. 2015;54(1):102-11. doi:10.1053/j.jfas.2014.09.010
- Ferrari J, Higgins JP, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev. 2004;(1):CD000964. doi:10.1002/14651858.CD000964.pub2
- Lapiplasty Procedure Surgical Technique and Patient Outcomes. Treace Medical Concepts. Published clinical data 2018-2023. Available at: https://treacemedical.com/lapiplasty-3d-bunion-correction/clinical-evidence/
- American College of Foot and Ankle Surgeons. Clinical Practice Guideline: Hallux Valgus. 2018. Available at: https://www.acfas.org/
- Coughlin MJ, Jones CP. Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2007;28(7):759-77. doi:10.3113/FAI.2007.0759
About Tanglewood Foot Specialists
Dr. Andrew Schneider has been treating bunions and other foot conditions in Houston for over 25 years. Tanglewood Foot Specialists offers comprehensive conservative care and advanced surgical techniques including Lapiplasty 3D bunion correction. The practice is located in Houston, Texas.
Contact Information: Phone: 713-785-7881 Request an appointment online
Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment recommendations specific to your situation.
