Reviewed for medical accuracy by Dr Evelyne Jonniaux, Medical Advisor
Last updated 17 September 2026
Waiting a year before operating on a bunion does not compromise the result. In the only randomised trial with a genuine no-treatment arm, all three groups had the same pain at two years. Surgery relieves sooner, not better in the end.
The questions we get asked
Does it inevitably get worse?
Not at the pace people imagine. The only longitudinal radiographic cohort we found followed 542 feet for nearly seven years in people over 50. The mean annual progression of the angle is 0.19 degrees, and only one foot in six progresses by at least one degree a year.
How does surgery compare with an orthosis, or with nothing?
The Finnish trial randomised 209 patients between surgery, an orthosis and a one-year waiting list. At one year, 83 percent of operated patients report improvement, against 46 percent with an orthosis and 24 percent with nothing. The gap is clear and it is real.
But the two-year follow-up, much less often cited, changes the reading. At two years pain intensity is the same in all three groups, and so are total costs. The reason is simple: 43 of the 69 patients in the orthosis arm and 48 of the 69 in the no-treatment arm had ended up being operated on. The authors conclude that immediate surgery is superior to delayed surgery, but that waiting a year does not compromise the final result.
Do orthoses correct the deformity?
No data on angular correction by an orthosis was found. What is demonstrated is an effect on pain at six months, of the order of 14 points out of 100 against no treatment, which no longer exists at two years.
What is the real recurrence rate?
It depends entirely on the threshold used and the length of follow-up, which is why the quoted figures vary so much. A meta-analysis of osteotomies followed for 8 to 14 years gives 40 percent recurrence at a 15 degree threshold and 2 percent at 25 degrees. The 4.9 percent from short follow-up series is explicitly described as an underestimate by those same authors.
One nuance the meta-analysis does not settle: an angular recurrence is not necessarily a painful one.
Is minimally invasive surgery better?
Three meta-analyses on the same question conclude respectively that it is superior, equivalent, and inferior on function. The most rigorous, restricted to randomised and prospective controlled trials, finds 4 points of difference on a functional scale whose clinically important threshold its own authors set at 29 points.
What the figures say
| Finding | Figure | Source |
|---|---|---|
| Mean annual progression of the angle after 50 | 0.19 degrees per year | J Orthop Sci, 2026 |
| Feet progressing at least 1 degree a year | 16.1 percent | J Orthop Sci, 2026 |
| Patients improved at 1 year | 83 percent surgery, 46 orthosis, 24 no treatment | Torkki et al., JAMA, 2001 |
| Pain at 2 years | identical in all three groups | Torkki et al., Acta Orthop Scand, 2003 |
| Conservative arms eventually operated by 2 years | 43 of 69 and 48 of 69 | Torkki et al., 2003 |
| Recurrence at 8 to 14 years by threshold | 40 percent at 15 degrees, 2 percent at 25 | Lalevée et al., EFORT Open Rev, 2024 |
Two figures we could not source. “95 percent of patients satisfied”: the only randomised figure available is 83 percent improved at one year. And “high heels cause bunions” rests on no causal demonstration; age and female sex are associations, not established causes.
What Noria Health does, and does not do
We organise a foot surgery consultation with a specialist team near Brussels, including review of existing radiographs and measurement of the angles. Feasibility confirmed within 24 to 48 hours, follow-up documented at D14, D30 and D90, and walking resumed around the 10th day where appropriate.
We do not set a surgical indication remotely, we do not measure an angle from a photograph, and we never advise bringing forward or postponing an operation already agreed with your surgeon.
Who reviewed this page
Noria Health editorial team.
See also: all our articles on posturology and podiatry.
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