The authors present a follow-up of the Austin bunionectomy using a single 2.7-mm American Society of Internal Fixation (ASIF) screw. At a mean 5-year follow-up, 45 feet in 32 patients were evaluated with information from clinical examination, radiographic data, and responses to a patient questionnaire. When compared to the 18-month follow-up, good reduction of the intermetatarsal and the hallux abductus angle were maintained. Clinical findings, including the first metatarsophalangeal joint range of motion and hallux purchase power, remained acceptable, and a small number of new transfer lesions were noted. Patient satisfaction with appearance and overall satisfaction with the procedure remained excellent-to-good in 96% of the procedures.