We might be obsessed with not having feet like our grandmothers or mothers, but there is a right time and a wrong time to have surgery. At the same time, you can be operated on at any age; 35-45 offers optimum results, lower risks, and greater optimism for success. Bunion bump removal surgery (exostectomy) alone is never recommended in the presence of hallux valgus in younger, healthy, mobile, active patients. The short-term benefit and high recurrence from removing bumps make this undesirable.

Under Twenty

Babies can be born with a bunion, but this is rare and considered part of the pressure associated with the uterus; it is just as likely to have a club-shaped foot as a bunion. The latter incidence is around 1 in 1000. The age of bone growth maturity is around 15-17 (girls) and 16-19 (boys).  It is possible to have surgery and require a repeat not just once but twice. Our youngest patient was 14, but the most severe bunion was in a 9-year-old.

Children scar more than adults, and this can add to concerns. Surgery at 14 can still require surgery at 20. The only justification for juvenile surgery (under 16) is for pain and damage to the skin with infection. Even surgery as an adult can see recurrence, albeit slower in progression.

The Twenties

Recovery is excellent when young. Return to full function requires little rehabilitation, but skin scars can still appear livid. The recurrence of larger deformities arises frequently, so long-term benefits in later life are not assured.

The Thirties

The deformity reoccurs slightly less after age 30-35 than in earlier years following surgery. Depending upon the source you read, there is a 7-15% reoccurrence risk. Though sometimes it is inevitable. Bunion surgery is successful in 70-80% of cases, but about 20% of patients may not be as satisfied as they might like, and this is a great disappointment for us. Starting a family after thirty+ is common today, especially for those who have yet to settle down or have a significant career. Teachers have more challenges, especially if they have been pressured to return to school too early.One patient, aged 29, took three years for her joint to return to 60 degrees of movement after large surgery. Severe means the deformity was over 45 degrees, and after surgery, it took time to become mobile again. 

The Forties

Ages – 40-59 do very well, although healing is slightly slower. Pain control is effective if you follow all the ground rules. Of course, by now, the deformity might have increased, and those secondary features such as hammertoes, corns and a callus may have arisen. Combining surgery with other problems has to be considered, and recovery is longer than when younger. Bunion surgery is carried out more between 40 and 65 than any other age. If your GP says your bunion is not ripe yet, they mean it is not severe enough for surgery. In the UK, this can often be a term to stop the NHS from overloading, where waiting lists are long.

Sixty Plus

Sixty-year-olds remain active today, so it is best to apply the same attitude to someone who wishes to remain active in good health. Our oldest patient was 94 and, while in good health, was troubled by damaged skin. Healing ability can drop, and the skin is more fragile, but pain is better tolerated by many in this age group. Local anaesthetic is much better in the older group, especially if their health is poor. Simple surgery is better, and this is where bump removal is an advantage, restoring earlier mobility and independence. One of our concerns is ensuring patients have someone around to support their needs. You can read — Tales of Foot Surgery from Jane.