Who Performs Bunion Surgery
Both podiatric foot and ankle surgeons and orthopedic surgeons are qualified to perform bunion surgery, though the evidence shows both specialties have distinct training pathways and areas of emphasis.
Provider Qualifications
Podiatric Foot and Ankle Surgeons
- Podiatric foot and ankle surgeons are specifically trained in foot and ankle pathology and are appropriate providers for bunion surgery 1
- Guidelines explicitly reference podiatric foot and ankle surgeons as appropriate specialists for foot deformities including bunions 1
- Podiatrists can perform bone biopsies and surgical procedures on the foot 1
Orthopedic Surgeons
- Orthopedic surgeons, particularly those with foot and ankle fellowship training, are qualified to perform bunion surgery 2
- Pediatric orthopedic surgeons manage limb malformations and deformities in children 1
- Orthopedic surgeons are recognized as appropriate providers for complex foot reconstruction 1
Clinical Decision-Making for Referral
For symptomatic bunions requiring surgical intervention after failed conservative management, referral to either a podiatric foot and ankle surgeon or an orthopedic surgeon with foot and ankle expertise is appropriate 2.
When to Refer
- Painful prominence with failed non-operative treatment (accommodative footwear, NSAIDs, orthotics, splints/braces, toe spacers) 2
- Patient is a suitable operative candidate 2
- Recurrent ulcerations in diabetic patients with bunion deformities not amenable to conservative footwear therapy alone should be referred to an experienced diabetic foot surgeon 1
Important Caveats
- Cosmesis alone is NOT an indication for bunion surgery 2
- Smoking is a relative contraindication; cessation is recommended before surgery 2
- In pediatric or adolescent patients (juvenile bunion), surgery should be delayed until skeletal maturity 2
Practical Considerations
The choice between provider types may depend on:
- Complexity of deformity: Complex limb-threatening deformities require experienced surgeons with appreciation for both the deformity and patient complexities 1
- Associated conditions: Diabetic patients with foot deformities including bunions should be referred to foot care specialists for evaluation 1
- Local expertise: The most important factor is the surgeon's specific experience with bunion correction, regardless of specialty designation 1
Both specialties perform minimally invasive and percutaneous bunion correction techniques 3, 4, indicating overlapping surgical capabilities.