When I was 19, a podiatrist
When I was 19, a podiatrist told me I needed bunion surgery on my left foot but I insisted on waiting until it really hurt...19 years later, in 2008, I relented and went back for surgery. That bunion was so huge it was wearing holes in all my left shoes and I could barely walk even BF. The bone was cut and repositioned, then pinned, in addition to being smoothed down. The recovery was definitely a frustrating 8ish weeks in spite of the snow and cold, but once out I was able to get back mileage pretty quickly. Fortunately I have a running/walking partner who was patient with my pace, but made me get outside frequently enough that I credit her pushing me through the initial healing pain with breaking up of scar tissue and why it doesn't hurt at all now. Orthotics were fitted yes, but no physical therapy, and most of all, no regrets.
This summer I started to transition and so ditched the orthotics completely and shoes mostly. I do wonder sometimes if I could have avoided or reversed the damage had I known then what I do now, but regardless, am hoping that I can avoid future problems now that I'm gradually conditioning my foot muscles. I also am very curious to know what my foot doc would say to all this.
Good luck!