How Is a Bunion Assessed Before Surgery?

A careful preoperative assessment is essential because the visible prominence does not reveal the full nature of a bunion. Two people with similar-looking feet may require different treatment because their joint alignment, mobility, arthritis, symptoms and mechanical pattern are different.

The consultation begins with the history of the problem. Important details include when symptoms began, which shoes or activities aggravate them, whether pain is located over the prominence or within the joint, and whether the second toe or ball of the foot is also affected.

The clinical examination assesses the position of the big toe, skin irritation, joint range of motion, tenderness, stability of the first ray, the lesser toes, arch structure and the way the foot functions during standing and walking. Circulation, sensation and skin quality are also reviewed because they influence healing and risk.

Weight-bearing X-rays are usually obtained when surgery is being considered. Standing images are more informative than non-weight-bearing films because they show how the bones align under normal load. Measurements assist with classifying the deformity and selecting an appropriate correction.

The X-rays also help identify arthritis, joint incongruency, sesamoid displacement, previous fractures, bone quality and deformity elsewhere in the forefoot. Advanced imaging is not routinely required for an uncomplicated bunion, although it may be considered when another condition is suspected.

The medical assessment includes current medications, allergies, smoking or nicotine use, previous problems with anaesthesia, clotting history and conditions that may affect wound or bone healing. The planned operation, likely recovery and postoperative support should then be matched to the patient’s circumstances.

This assessment is also the time to discuss expectations. The aim is usually to reduce pain, improve alignment and make footwear easier, but no operation can guarantee a perfectly shaped foot, complete absence of swelling or unlimited shoe choice.