Before bunion surgery, weight-bearing X-rays are an important part of planning. They allow us to measure the angles of the bones, understand the severity of the deformity, and decide how best to realign the foot. These measurements help us select a procedure that is most likely to correct the bunion and create a balanced, stable result.

But an X-ray cannot tell the whole story.

X-rays can reveal signs of arthritis, including narrowing of the joint space, bone spurs, and irregular joint surfaces. What they cannot fully depict or predict is how a joint will feel or move after surgery. Age, activity level, cartilage wear, stiffness, pain tolerance, and personal recovery goals all affect the final result.

What X-rays help assess

• Toe and metatarsal alignment
• Joint-space narrowing
• Bone spurs and joint-surface changes
• Severity and location of deformity

What they do not tell us

• How much pain a person feels
• How much motion is comfortable
• How much motion is available in a joint
• A person’s age or overall health

A useful comparison is a tire that is out of alignment. A bunion is like the alignment problem: surgery can straighten the toe and bring the foot into better alignment. Arthritis is like worn tread on the tire. Correcting the alignment can improve how the tire tracks, but it cannot replace rubber/ tread that has already worn away.

Similarly, bunion surgery can straighten the big toe and reduce the prominence of the bunion, but it cannot restore cartilage or make an arthritic joint move smoothly again. A patient may have a beautiful X-ray after surgery and still experience stiffness or discomfort if arthritis was already present in the big-toe joint.

For some patients—especially those with a severe bunion, substantial arthritis, or a desire for the most durable and predictable correction—a joint fusion may be the better option. A fusion corrects the alignment while also eliminating painful arthritic motion by permanently joining the joint. The tradeoff is that the big-toe joint will no longer bend, so this choice deserves a careful, individualized discussion.

Other patients may reasonably choose bunion correction while preserving the joint. This can provide excellent alignment and a much straighter toe. However, it is important to understand that pre-existing arthritis may continue to cause stiffness or discomfort, even after an otherwise successful correction.

Case Example

A patient consulted with several doctors before seeking a Lapiplasty consultation. Because of the patient’s age and extreme severity in the bunion, several physicians recommended joint fusion—the more predictable option in this situation.

Fusion can offer reliable pain relief, excellent cosmetic alignment, permanent correction of the bunion, and a relatively straightforward recovery. In fact, for highly active patients with severe big-toe joint arthritis, we often prefer fusion because—somewhat counterintuitively—it can make running, sports, and other activities more comfortable. We discussed the benefits and limitations of both fusion and joint-preserving bunion correction.

This patient strongly preferred a Lapiplasty and wished to preserve the joint, if possible. Although fusion may have appeared to be the more predictable option on paper, the joint did not seem severely damaged on exam, and preserving it appeard to be a reasonable goal. We proceeded with the patient’s informed preference.

The before-and-after X-rays show a textbook bunion correction:

✅ The previously severely crooked toe is now straight and well aligned.
✅ The bunion prominence has been corrected.
✅ The foot can fit more comfortably into a normal shoe.
✅ The bone has healed within the expected recovery timeframe.
✅ All measured angles have returned to the normal range.
  ↳ Most impressively, the intermetatarsal (IM) angle improved from 19° to 3°     - An 8° or below IM angle  is normal, above 16°  indicates severe deformity.

The patient was very happy with the look of the foot immediately after surgery.  Many months after surgery, they noticed that the toe did not move more than it had before surgery and there was occasional swelling present—even after physical therapy. This can be understandably confusing.

So, What Happened?

Surgery corrected the alignment, but it could not reverse the cartilage damage and arthritis that had developed over many years. The anatomy had been improved, but the joint itself still had its pre-existing limitations. The ongoing stiffness and joint discomfort were consistent with the degree of pre-existing joint damage.

Swelling was likely worsened by returning to tight or less-supportive shoe gear—such as ballet flats or heels—too soon after surgery. Swelling overall can be a bit of a wild card: it is the body’s response to the trauma of surgery, and everyone responds differently. It is usually most noticeable during the first eight weeks after surgery, but residual swelling can take six months or longer to resolve completely before the foot is comfortable in a narrow or tight-fitting shoe.

Swelling can also create a frustrating feedback loop. The more the foot is pushed before it is ready, the more swelling and irritation may develop—and the longer it may take to settle.

Key point: The procedure achieved the patient’s goal of a Lapiplasty preserving the joint and correcting the bunion. However, given the pre-existing arthritis, it may not have been the most predictable option for restoring comfort and motion.

This case is also a reminder not to become too committed to one specific procedure before a complete evaluation. Doing your research and arriving with questions is valuable—we encourage it. But online information cannot fully account for your individual X-rays, joint condition, symptoms, activity goals, and long-term needs. What is right for one person may be bad for another. 

At Lincoln Park Podiatry, we have many options for bunion correction—not a one-size-fits-all approach. We make treatment decisions together, balancing your goals and preferences with what is medically reasonable and most likely to provide a durable, comfortable result.

The “best” procedure is not always the one with the most popular name, the shortest recovery, or the most "asthetic" scar. It is the one that gives your particular foot the best chance of a successful long-term outcome.

At Lincoln Park Podiatry we encourage patients NOT to wait until a bunion becomes severely painful or disabling before seeking an evaluation. As a bunion becomes more severe and persists for longer, arthritis in the joint may progress as well. Waiting can limit the available treatment options and, in some cases, make joint fusion or multiple procedures the more appropriate—or only—recommendation.

If you have a bunion and are unsure what to do, schedule a consultation today. Establishing a baseline early helps us understand your unique situation and preserve as many treatment options as possible.