What is a Bunion? (And Why Standard Surgery Often Fails)
A bunion (hallux valgus) is a complex three-dimensional bone deformity where your big toe drifts toward your other 
toes while the joint at the base pushes outward. The underlying problem is an unstable joint in the middle of your foot that allows your metatarsal bone to shift sideways, rotate, and elevate—creating the bump you see.
Most people think a bunion is just a bump that needs to be shaved off. But that bump isn't extra bone growth—it's your metatarsal joint being pushed out of position. Think of your first metatarsal bone as a tall building that should stand straight. With a bunion, this building isn't just leaning to one side—it's also rotating and lifting up.
The real culprit? The tarso-metatarsal (TMT) joint. That's the connection point in the middle of your foot where your metatarsal attaches to the smaller bones behind it. When this joint becomes unstable, it's like having a building with a faulty foundation. You can straighten the building temporarily, but if you don't fix the foundation, it'll start leaning again.
This is exactly why traditional bunion surgery has such a high recurrence rate. When you only address the sideways lean by cutting and shifting the bone over, but leave the unstable foundation joint and don't correct the rotation or elevation, the forces that created the original bunion are still there. Within five years, 70% of traditionally-treated bunions come back. That's not a small failure rate—that's seven out of ten patients seeing their bunion return.
How Traditional Bunion Surgery Works
Before I explain why Lapiplasty is different, you need to understand what traditional bunion surgery actually does. There 
are several types—Austin osteotomy, Scarf osteotomy, proximal osteotomy—but they all follow the same basic approach.
Traditional surgery makes a cut in your metatarsal bone, shifts it over to realign your big toe, then secures it in that new position with screws or pins. The surgeon also removes the bony bump and may release tight ligaments pulling your toe inward. On X-rays, it looks great. Your toe is straighter. The bump is gone.
But here's the problem: traditional surgery only addresses the sideways lean—what we call the transverse plane. It doesn't correct the rotation of the bone. It doesn't address the elevation. And most critically, it doesn't stabilize that unstable TMT joint in the middle of your foot that caused the bunion in the first place.
Here's what recovery from traditional bunion surgery typically looks like: You're completely non-weight-bearing for six to eight weeks. That means crutches or a knee scooter. No putting any weight on your surgical foot.
After that, you gradually transition to a surgical boot, then to supportive shoes around month three. Full recovery takes four to six months.
In the first year, most patients are happy. The pain is gone, the bunion looks better, and recovery is behind them. But then time passes. That unstable foundation joint is still there. The same biomechanical forces that created the original bunion gradually push the bone back out of position. Within five years, seven out of ten patients see their bunion returning. Some need revision surgery. Others just live with the disappointment.
How Lapiplasty Addresses the 3D Deformity
Lapiplasty isn't just a different cutting technique—it's a fundamentally different surgical approach. Instead of shifting 
the bone over in one dimension and hoping it stays, Lapiplasty corrects all three dimensions of the deformity and stabilizes the unstable joint that caused the problem.
Remember that 87% of bunions involve misalignment in all three dimensions? Lapiplasty addresses all three:
Transverse plane (side-to-side): Your metatarsal bone has shifted outward. Both traditional surgery and Lapiplasty correct this.
Frontal plane (rotation): Your bone has rotated, affecting how your toe touches the ground. Traditional surgery doesn't address this. Lapiplasty does.
Sagittal plane (elevation): Your metatarsal has lifted up. Traditional surgery doesn't correct this. Lapiplasty does.
But here's the most critical difference: Lapiplasty stabilizes that unstable TMT joint—the foundation that caused your bunion. Using advanced instrumentation, we precisely rotate and realign your metatarsal bone back to its natural anatomical position in all three dimensions. Then we use specialized titanium plates to permanently secure that foundation joint.
Think about it this way: if you have a leaning tower, you can straighten it temporarily by just pushing it over. But unless you fix the foundation causing it to lean, it'll start tilting again as soon as you walk away.
That's traditional surgery.
Lapiplasty rebuilds and reinforces the foundation, so the building stays straight. That's why the recurrence rate drops from 70% to less than 1%.
Because we're stabilizing the foundation joint with titanium plating, the correction is stable immediately. That means you can walk on it—in a surgical boot—within days of surgery.
Most of my Lapiplasty patients are walking by day two to five. No crutches. No knee scooter. No eight weeks of being completely off your feet.
Lapiplasty was developed after analyzing why traditional bunion surgery had such poor long-term outcomes. Surgeons realized they were treating a 3D problem with a 2D solution. The technology and instrumentation allow us to precisely correct what traditional surgery couldn't address. Since I started performing Lapiplasty, I rarely recommend traditional surgery anymore—the outcomes are simply better.
Side-by-Side Comparison: Recovery, Results, and Recurrence
Let's put these procedures side by side so you can see exactly how they compare. These aren't theoretical timelines—these are what my patients actually experience.
| Factor | Traditional Surgery | Lapiplasty |
|---|
| Initial Weight-Bearing | 6-8 weeks (none) | 2-5 days |
| Crutches/Scooter | Yes, 6-8 weeks | No |
| Return to Normal Shoes | 3-4 months | 8-12 weeks |
| Full Recovery | 4-6 months | 3-4 months |
| Corrects 3D Deformity | No | Yes |
| Stabilizes TMT Joint | No | Yes |
| 5-Year Recurrence Rate | 70% | <1% |
| Patient Satisfaction (5 years) | 50-60% | >90% |
The biggest difference you'll notice is in those first eight weeks. With traditional surgery, you're managing crutches or a knee scooter, trying to shower without getting your foot wet, and basically planning your whole life around being non-weight-bearing.
With Lapiplasty, you're walking in a boot within days. You can shower more easily. You can move around your house normally. It's a completely different experience.
By month two, traditional surgery patients are finally starting to bear weight and transition into a boot. Lapiplasty patients? They're already thinking about transitioning out of the boot into supportive shoes. The recovery timeline is compressed because the foundation was stabilized from day one.
But here's what matters most: five years later.
With traditional surgery, seven out of ten patients see their bunion coming back. They're frustrated, wondering if they should have surgery again, or just living with the disappointment.
With Lapiplasty, fewer than one in a hundred patients experience recurrence. That's not a small difference—it's the difference between a procedure that's likely to fail and one that's almost certain to succeed.
I won't pretend Lapiplasty isn't more expensive—the specialized instrumentation and titanium plates cost more. If you're paying out of pocket, Lapiplasty runs $12,000-$18,000 compared to $8,000-$15,000 for traditional. But if insurance covers it (and most do), your out-of-pocket costs are often similar. And when you factor in the potential costs of dealing with a recurrent bunion—more imaging, more appointments, possible revision surgery—Lapiplasty's higher upfront cost often saves money long-term.
The 70% Recurrence Problem Explained
You might be wondering: why does traditional bunion surgery fail so often? It's a legitimate surgical procedure, performed by skilled surgeons, with good short-term results. So what happens over those five years that causes seven out of ten bunions to come back?
Here's what's actually happening. When you shift the metatarsal bone over but don't stabilize the TMT joint, you're leaving the fundamental problem unaddressed. That joint is still hypermobile—it still has too much motion. Every time you walk, every time you push off with your foot, forces are being transmitted through that unstable joint.
At first, the screws or pins holding your bone in its new position are strong enough to resist these forces. But over months and years, the constant mechanical stress gradually overpowers the fixation.
Your metatarsal starts drifting back toward its original position. It's not a sudden failure—it's a slow drift that accelerates over time.
Most patients don't notice their bunion returning until it's already significant. By the time you're feeling pain again or seeing the bump enlarge, the bone has already shifted substantially. At that point, your options are living with it or having revision surgery—which has even lower success rates than the original procedure.
Lapiplasty prevents recurrence by addressing the unstable joint that's causing the problem. Those titanium plates don't just hold the bone in position—they permanently stabilize the TMT joint. It's like the difference between propping up a leaning building with a temporary support versus rebuilding the foundation with reinforced concrete. One might hold for a while; the other is a permanent fix.
Who Benefits Most from Each Approach
After examining over a thousand patients with bunions, I've developed clear criteria for which patients benefit most from each approach. This isn't about marketing one procedure over another—it's about matching the surgery to your specific situation.
When Traditional Surgery Might Be Appropriate
I'll be honest: since I started performing Lapiplasty, I rarely recommend traditional surgery. But there are some scenarios where it might be considered. If you have a very mild bunion without significant 3D deformity or TMT joint instability—and I've seen maybe three of these in the last two years—a simpler procedure might be sufficient. If insurance limitations make Lapiplasty not feasible and you're choosing between traditional surgery or no surgery, traditional might be better than continued suffering.
But you need to go into traditional surgery with your eyes open about that 70% recurrence rate. If you're willing to accept that your bunion will likely come back within five years, and you're prepared to deal with that outcome if it happens, then traditional surgery can provide several years of relief. For some patients, that's an acceptable trade-off. I won't judge you for making that choice—just make it as an informed decision.
Ideal Candidates for Lapiplasty
Most of my bunion surgery patients are ideal candidates for Lapiplasty. If you have a moderate to severe bunion with 
3D deformity—which is 87% of bunions—Lapiplasty addresses your problem more completely. If your bunion has been progressively getting worse despite conservative treatment, that's a sign of an unstable TMT joint that needs stabilization.
Lapiplasty is particularly valuable if you're active and can't afford to be off your feet for eight weeks. Whether you're training for a half marathon on Houston's Memorial Park trails, standing all day at work, or caring for small children at home—the ability to walk within days makes a huge difference in your life.
If you've already had traditional bunion surgery and your bunion has come back, Lapiplasty is almost always my recommendation for revision surgery. We now know why your first surgery failed—the foundation wasn't stabilized. Repeating the same approach that didn't work makes no sense. Lapiplasty gives you a much better chance at definitive correction.
Patients Who May Not Be Surgical Candidates
Some patients aren't good candidates for any bunion surgery. If you have severe arthritis with bone-on-bone contact in the joint, you might need a fusion procedure instead. If you have active infection, severe peripheral vascular disease, or certain bone conditions affecting healing, surgery carries higher risks. And if your pain is manageable with conservative treatment and you're not functionally limited—you might not need surgery at all.
What Conservative Treatment Can Still Do
Before we go further into surgical options, I need to address something important: not everyone researching bunion surgery actually needs surgery. In most medical offices, doctors are trained to think in terms of medicate or operate.
But I believe there's often a third option worth exploring first.
If your bunion is mild to moderate, if your pain is manageable most of the time, and if you haven't tried comprehensive conservative treatment—surgery shouldn't be your first step. Custom orthotics that precisely redistribute pressure away from your bunion joint, appropriate footwear with a wide toe box, and sometimes targeted injections for acute inflammation can make a significant difference.
About 60-70% of patients find acceptable pain relief with this approach.
But here's the honest truth: conservative treatment can't reverse a bony deformity or stabilize an unstable joint. If your bunion is significantly progressing, if you can't find any comfortable shoes, if your pain limits your daily activities despite proper orthotics and footwear—conservative treatment has done all it can do. At that point, continuing to avoid surgery isn't delaying the decision. It's just extending your suffering.
For patients with soft tissue inflammation around their bunion—bursitis over the bump, capsulitis of the joint—shockwave therapy and PRP injections can sometimes provide significant relief. I want to be very clear: these treatments don't fix the structural deformity. They can't stabilize your TMT joint. But they can reduce inflammation and buy you time if you need to delay surgery for timing reasons or if you have medical conditions making surgery higher risk.
If you've tried appropriate conservative care for six months without improvement, if your bunion continues to enlarge despite your best efforts, or if your quality of life is significantly affected—it's time to have a serious conversation about surgery. Waiting years hoping your bunion will stop progressing on its own doesn't work. Either way, I need to see you so we can assess what's actually happening in your foot and make a plan that fits your goals.
Houston Podiatrist's Surgical Decision Criteria
After 25 years of performing bunion surgery—first with traditional techniques, then with Lapiplasty—I've developed a clear framework for when surgery is appropriate and which procedure gives each patient the best outcome.
Let me walk you through exactly how I make these decisions.
When you come in for a bunion evaluation, I'm looking at several factors. First, the severity of your deformity—the angle of your bunion, the position of your sesamoid bones, whether your toe can be manually corrected or is rigid.
Second, your symptoms. Is your pain primarily from the bunion joint itself, from pressure on the bump, or from secondary problems like hammertoes or metatarsalgia?
I also want to know what you've tried already. Have you worn appropriate shoes consistently? Have you tried quality custom orthotics—not drugstore inserts, but professionally-made devices? How long have you dealt with this? If you've never tried conservative care, I'm usually going to recommend starting there unless your bunion is severe or rapidly progressing.
But here's what matters most: how is this affecting your life? Can you do the activities that matter to you? Can you wear reasonable shoes? Is pain limiting your work, exercise, or daily activities?
That's the goals-over-symptoms approach. I'm not just looking at the X-ray—I'm listening to what you're telling me about what you want to be able to do.
I recommend surgery when conservative treatment has genuinely failed, your bunion is significantly affecting your quality of life, and you're motivated to commit to the recovery process. I need to see at least three to six months of appropriate conservative treatment first—unless your bunion is severe or you're developing complications like skin breakdown over the bump.
For surgical candidates, I recommend Lapiplasty for the vast majority of my patients. If you have a 3D deformity with TMT joint instability—which, again, is 87% of bunions—the evidence is clear that Lapiplasty gives you better long-term outcomes. The only time I might consider traditional surgery is for the rare patient with a very mild bunion without TMT instability, or when insurance limitations make Lapiplasty truly not accessible.
If we decide surgery is appropriate, I'll order weight-bearing X-rays to assess the exact angles and deformity. We'll discuss your schedule, recovery expectations, and any medical conditions that might affect healing. I'll explain exactly what the surgery involves, what recovery looks like week by week, and what success rates you can realistically expect. You should leave that appointment with a clear understanding of what you're committing to and what outcomes you can expect.
Ready to find out which approach is right for your bunion? Schedule your evaluation with Houston podiatrist Dr. Andrew Schneider. Call 713-785-7881 or request your appointment online.
What to Expect from Surgery and Recovery
Look, I know foot surgery sounds scary. The idea of someone cutting into your foot, the recovery time, the uncertainty 
about results—it's completely understandable to be nervous.
But here's what I need you to know: modern bunion surgery, done correctly, has excellent outcomes. And when conservative treatment has failed and your bunion is affecting your quality of life, surgery works.
Once we schedule your surgery, we'll review everything you need to do beforehand. If you're on blood thinners, we'll coordinate with your primary doctor about temporarily stopping them. You'll need to arrange for someone to drive you home and stay with you the first 24 hours. Most Lapiplasty procedures are done at an outpatient surgery center, so you go home the same day.
On surgery day, the procedure typically takes about an hour. You'll have either general anesthesia or sedation with a local anesthetic block. I use ultrasound guidance to ensure precise placement of the correction and titanium plates.
You'll wake up in recovery with your foot in a surgical boot, some numbness from the block, and prescriptions for pain management.
Week-by-Week Recovery (Lapiplasty)
For the first few days, your main job is to rest, elevate your foot above your heart level, and manage swelling with ice. By day two to five, most patients are walking in their surgical boot—carefully at first, but walking nonetheless. You'll come back around day 10-14 for your first follow-up when we typically remove stitches and check your healing.
During weeks three through eight, you're gradually increasing your walking time in the boot. Most patients can return to desk work within two to three weeks. You're showering more easily now (with a cast cover). Pain is manageable with over-the-counter medication. Around week six, we'll take new X-rays to confirm your bone is healing properly.
By month three, most patients are transitioning out of the boot into supportive athletic shoes. You're walking normally, returning to most daily activities, and starting gentle exercise like swimming or stationary biking. By month four to six, you're back to the activities you love—hiking, running, or just walking comfortably in regular shoes.
Traditional Surgery Recovery for Comparison
If you choose traditional surgery, expect those first six to eight weeks to be much more challenging. You'll be completely non-weight-bearing, which means crutches or a knee scooter, making simple tasks like showering or getting to the bathroom complicated. Recovery is longer overall—usually four to six months before you're back to full activities.
Both procedures involve swelling that can persist for months. Your foot may continue to have some swelling at the end of the day for up to a year—that's normal and doesn't mean anything's wrong. You may have some stiffness in your big toe initially, but range-of-motion exercises help restore movement. And yes, you'll have a surgical scar—but most patients find it fades significantly over time and is a small price to pay for a corrected bunion.
What to Expect When You Come In
When you come in for a bunion evaluation, I'll start by listening to your story. How long have you had this bunion? What shoes can you still wear comfortably? What activities are you avoiding because of pain?
These questions help me understand not just what's wrong with your foot, but how it's affecting your life.
Then I'll examine your foot. I'm looking at the angle of your big toe, checking if I can manually straighten it or if it's rigid, feeling for tenderness around the joint and along the metatarsal. I'll watch you walk to see how your foot functions during motion.
This tells me whether your bunion is just a structural problem or if it's also creating issues with how you move.
If I haven't seen recent X-rays, I'll order weight-bearing films right there in the office. These are critical because they show me the exact angles of your deformity and help me see what's happening with that TMT joint we've been talking about.
The whole appointment usually takes about 30-45 minutes.
Once I have all this information, we'll talk about your options. If you haven't tried conservative care yet and your bunion isn't severely progressed, I'll typically recommend starting with custom orthotics and appropriate footwear. We'll give that approach three to six months. But if you've already done conservative treatment without success, or if your bunion is severe and progressing rapidly, we'll discuss surgical options—and I'll explain exactly why I'm recommending Lapiplasty over traditional surgery for your specific situation.
You'll leave that first appointment with a clear plan. Either we're starting conservative treatment with a follow-up in a few months, or we're scheduling surgery with a detailed timeline of what happens next.
No pressure, no confusion—just a straightforward path forward based on your goals and your foot.
Questions to Ask Before Scheduling Surgery
Whether you schedule surgery with me or another podiatrist, you deserve clear answers to these important questions. Don't be afraid to ask—any surgeon who gets defensive about legitimate questions isn't someone you want operating on your foot.
1. What percentage of your bunion surgeries are Lapiplasty vs. traditional?
If a surgeon rarely performs Lapiplasty, they may not be as comfortable with the technique. You want someone who routinely uses the approach they're recommending.
2. What is your personal recurrence rate for the procedure you're recommending?
National averages are helpful, but your surgeon's individual outcomes matter more. If they can't or won't share their statistics, that's a red flag.
3. How many of these procedures have you performed?
Experience matters in surgery. Ideally, your surgeon should have performed at least 50-100 of the specific procedure they're recommending.
4. Will you stabilize my TMT joint?
This is the question that determines if you're getting true 3D correction or just a traditional approach with different marketing.
5. When will I be able to walk, work, and exercise?
Get specific timelines, not vague answers. Recovery expectations should be clear and realistic.
6. What is covered by my insurance, and what are my out-of-pocket costs?
Financial surprises after surgery add unnecessary stress. Know your costs upfront.
7. What happens if I'm not happy with the result?
Understand the revision policy and what would be done if outcomes aren't satisfactory.
