Who Should Perform Your Surgery?

The most important criteria to ensure good outcome for your bunion surgery is to choose the right surgeon.
The qualities that make for a good bunion surgeon are:

• Board Certified: Look for an experienced surgeon who is board certified by the American Board of Podiatric Surgery (only board recognized as a surgical board) in Foot Surgery or Foot and Ankle Surgery.
• Understanding of biomechanics: To choose the best procedure, a surgeon must also have the ability to evaluate your biomechanical structure including tightness of leg muscles, foot and leg alignment, motion of the bones around the bunion site, and midfoot and rearfoot alignment.
• Extensive experience: An experienced surgeon usually has a better ability to deal with intraoperative or post operative complications and reduce the chance of complications. Numerous studies have demonstrated that one of the best predictors of surgical outcome is the experience of the surgeon.
• Gentle handling of tissue: A surgeon who handles tissue with a gentle touch will help ensure that pain is minimized and recovery time is reduced.
• Performs surgery in peer reviewed hospital or surgery center (surgery center not located in physician’s office)

  Not all Surgeons are Created Equal:

  Be very careful in choosing the right surgeon. It is particularly important to avoid those that make unrealistic claims regarding bunion surgery. If you see or hear the following statements we suggest you consider another surgeon:
  • "90 plus percent of patients have pain free surgery": Most surgeons could make that claim since surgery is generally performed with a local anesthetic block and the patient is sedated or asleep during surgery. After surgery patients are given a long term anesthetic block to allow them to usually go home pain free. Look for a surgeon who gives realistic expectations and does not make surgery sound too good to be true.
  • “I created a better bunion surgery”: There are several problems with this statement. First, all bunion surgery is a variation on several basic types of procedures. There have been substantial evolutionary changes over the years, but if you hear anyone claiming that they have invented a procedure that is far better than anyone else is using, you should have a healthy skepticism. Second, there is no one “best” bunion surgery. The correct procedure depends on your foot shape, ligament tightness, biomechanics and other factors. Finally, in most all surgical specialties, if a truly better procedure is developed it is adopted by most good surgeons.
  • “My patients never have a bunion return”: It is simply impossible to ethically guarantee that a bunion will not return. The odds of a bunion returning are much less if the surgeon chooses the right procedure and the patient follows all of their post-operative instructions. Also the use of custom foot orthotics (specifically prescribed to enhance normal function of the big toe joint) after surgery can help prevent return of bunions. The reality is a very small percentage of bunions will eventually return regardless. Sometimes the forces leading to bunion formation are just too great.
  • “My patients never require crutches”: This often means that the surgeon only knows how to perform a simple type of bunionectomy. More complex bunion procedures may require the use of crutches. In fact, even with a bunion procedure that allows early weight bearing most surgeons will have their patients use crutches for short period of time to reduce swelling and pressure on the surgical site.
  • “Surgery is performed in our own surgery center”: Be VERY cautious of a physician who performs bunion surgery in their own office surgery center. Physicians who perform surgery in the hospital must pass a credentialing process and be approved by a committee to perform individual surgical procedures. Physicians in the hospital are re-credentialed/evaluated on a regular basis. This assures you the physician is qualified to perform your surgical procedure and does not have an impairment. An office surgery center must usually be approved, in order for them to bill Medicare, but the physicians are not regulated. A physician may be deemed not qualified to perform a procedure in the hospital but this does not stop him/her from performing procedures in his/her own surgery center. A physician operating in his/her own surgery center has no one evaluating the quality of work. (We tend to see more complications from patients who have had surgery in an office surgery center).
  • “I feel your bunion is going to get worse so you should have surgery as soon as possible”: Be cautious of a physician who does not suggest conservative therapy before suggesting surgery.
  • “Surgery is virtually pain free, minimally invasive”: Be cautious of a physician who makes the surgery sound too good to be true. “Minimally invasive” bunion surgery was a term used many years ago to describe bunion surgeries performed through a very small incision. Due to significant numbers of complications with minimally invasive bunion surgeries, it is not currently recommended for bunion correction. A responsible surgeon will give you realistic expectations and review possible complications. All surgery, bunion or otherwise may have possible complications.