Surgical referral

Bunion surgery referrals should only be made when all conservative approaches to manage the three elements alignment, integrity of tissue and pain to influence mobility have been achieved.

The aims of management come under the mnemonic M.A.I.D. The podiatrist will apply management to A-I-D to manage Mobility. Each element is indicated by brackets below.

The origins of MAID were first recorded in Tollafield & Merriman 1987 and applied to surgery and has been updated to apply to all podiatric principles of management.

A professional lecture is available on the subject of the bunion (hallux valgus) for clinicians. Please see the Missing Lecture and other information covering talks provided by the author. 


When to refer for Bunion Surgery

  • Mobility (M) is reduced limiting capacity to function
  • Foot discomfort (D) everyday shoes affected.
  • Footwear education is required.
  • Discomfort (D) levels of pain assessed 0-10 scale 3 upwards may be a concern
  • Secondary features (A.I.D) override all aspects of deformity
  • Irreversible tissue concerns (I) superimposed by medical factors
  • Where orthoses, splints and taping fail (A)
  • Proximal problems e.g knee, hip and back
  • Surgery should achieve all aims of M.A.I.D

* Surgical risks from bunion surgery are varied and a fuller description can be found in the patient journey book Tollafield, DR. Bunion. Hallux Valgus. Behind the Scenes. 2019. pp 129-140. Available from Amazon books (E-book and paperback versions)

Cautionary Reasons for Bunion Surgery

  • Avoid promotion for cosmesis
  • Use of surgery for footwear style enhancement
  • Prevention in association with heredity

Surgical Risks Bunion Surgery*

  • Reoccurrence 7-15%
  • Failure 10-15%
  • Stiffness in toe
  • Limited with some shoes
  • Increased pain e.g scars, transfer metatarsalgia

This is a quick reference article for surgical referral for the professional and is provided to support talks on management of the bunion. The material is for reference only and discussion in tutorial and professional talks and lectures on the subjects by qualified clinicians. It can also be used by patients considering surgery when discussing the subject with their chosen clinician.


Thank you for reading about when to refer for bunion surgery written by David R Tollafield and published by BusypencilCase Communications Ltd. December 2019