A bunion does not automatically require surgery. Many people have a visible hallux valgus deformity but little pain, while others have a smaller-looking bunion that significantly affects walking, footwear and daily activity. The decision to operate should therefore be based on the person’s symptoms and functional limitations rather than the size of the bump alone.
Surgery is commonly discussed when pain remains persistent despite appropriate footwear changes, activity modification, padding, orthotic therapy where indicated and other reasonable conservative measures. Difficulty finding comfortable shoes, recurrent inflammation over the joint, progressive crowding of the lesser toes and reduced ability to walk or exercise may also support consideration of surgery.
The consultation should explore how often symptoms occur, which activities are restricted and whether the patient’s expectations are realistic. Weight-bearing X-rays are usually required to assess the alignment of the first metatarsal and big toe, the condition of the joint and the severity of the deformity.
The goal is not to operate at the earliest opportunity. It is to identify the point at which the likely benefit of correction reasonably outweighs the inconvenience, recovery demands and recognised risks of surgery.