Can a Bunionectomy Ever Be Just a Cosmetic Procedure?

There is a controversy in the podiatry industry as to whether bunionectomy can be performed for purely cosmetic reasons. Let’s say a patient does not experience any joint or bump pain, but he or she is interested in surgical intervention, should this be considered medically necessary or cosmetic? When it comes to foot surgeries, cosmetic approaches are now emerging, and they are moving full steam ahead.

The American College of Foot and Ankle Surgeons (ACFAS) are against aesthetic treatments for bunions because it does not have any medical benefit. Other foot and ankle surgeons, however, are for performing correction of foot deformities for hammertoes and bunions for their patients to fit better into shoes, and to have narrower, aesthetically-appealing feet.

Whether you are in favour of cosmetic foot surgery or not, it is important to keep in mind that it is our obligation to disclose all to the patient – the potential risks, pros and cons, and complications. We are also obliged to outline the proposed course of treatment carefully and to provide the best surgical outcome we can.

The bottom line is, some bunionectomies are necessary for medical purposes while other bunions are an aesthetic concern. Bunions, nonetheless, are legitimate concerns of the patient population and these patients come to us for advice.

When patients present to our Toronto Podiatry office, there are usually four main reasons why they take the initiative in making the appointment:

#01. The patient has pain at the big toe joint. These are the patients who have no pain and limitation of activity. Most of them have no problems when they are wearing shoes. It is important to educate these patients about the condition and to discuss all their options.

#02. The patient finds it difficult to fit shoes comfortably.

These are the patients who have tried conservative care, but to no avail, and they are now ready for surgery. This is definitely not just a cosmetic case, and these patients need to have surgery to reduce the symptoms and to be able to get back to having pain-free activities.

#03. The patient does not like the way the deformity looks.

These patients can often relate to the inability to fit into their shoes. Now, this actually becomes the gray area of controversy. So, if the patient cannot fit into his or her shoes, does this then support the need for surgery? If the patient has a wide forefoot and narrow rearfoot, then he or she has limited shoe choices. There are many wider shoes on the market, but it can be difficult for them to find shoes that fit. In such circumstance, does a surgeon who does not believe in bunionectomy for a pain-free foot agree now that the procedure is warranted?

No matter which side of the discussion you are for, it is always best to practice with sincerity and ethics. We try to disclose all relevant information to our patients.

#04. The patient experiences some combination of numbers one, two and or three.