Bunions

Published by Bupa’s Health Information Team, July 2011.

This factsheet is for people who have bunions, or who would like information about them.

A bunion is a bony lump that develops at the base of the big toe. A bunion can be painful and affect walking. If the bunion is very painful and other treatments don't work, surgery may be needed.

About bunions

A bunion is a bony lump on the side of your foot, which develops when your big toe starts to angle towards your second toe. The bunion eventually causes discomfort and pain. The skin over the lump can become red, blistered or infected. A fluid-filled space called a bursa may also develop under your skin in this area and this can be painful if it becomes inflamed. This is called bursitis.

Symptoms of bunions

If you have a bunion, you may have:

• pain or stiffness of the big toe joint
• swelling of the big toe joint
• difficulty walking
• difficulty finding shoes that fit

If you have any of these symptoms, see your GP.

Causes of bunions

A bunion occurs as a result of a problem with your big toe known as hallux valgus. Hallux means the big toe and valgus means that it’s pointing outwards towards the other toes.

In hallux valgus the bone in your foot at the base of your big toe, called the first metatarsal, moves out at the side of your foot. Your big toe angles towards your other toes.

There is evidence that people can inherit a tendency to develop bunions. However, it doesn’t always follow that if your parents or grandparents have bunions, you will have them too.

Hallux valgus affects more women than men. This may be because the ligaments in the foot (the structures that connect bones together) are usually looser in women than men.

The type of shoes you wear may also affect the development of a bunion. If you wear narrow or high-heeled shoes, this puts extra strain on the bones and muscles in your foot, pushing your toes together and forcing your big toe to point towards your other toes. Footwear alone doesn’t cause bunions, but it can worsen them.

Bunions are also sometimes associated with joint diseases including osteoarthritis. However, there is usually no serious underlying cause.

Diagnosis of bunions

Your GP will be able to diagnose a bunion by asking about your symptoms and examining your foot. You may also have blood tests or an X-ray to assess your bones and joints and to rule out any other medical condition, such as rheumatoid arthritis or gout.

Treatment of bunions

Wearing the right shoes, using shoe inserts and padding and taking painkillers can all help to ease the symptoms of a bunion. However, these treatments can’t cure a bunion or stop it getting worse. If you have severe pain or discomfort from a bunion, you will need to have an operation to correct it.

Self-help

One of the most important things you can do is to wear the right footwear. You should try to wear flat, wide shoes with laces or an adjustable strap that fits you properly. You may also want to use a bunion pad over your bunion to give you some protection from the pressure of your shoes. You can usually buy these pads from a pharmacy or from your chiropodist or podiatrist.

Medicines

You can take over-the-counter painkillers such as paracetamol or ibuprofen to help relieve the pain and inflammation of your bunion. Always follow the instructions in the patient information leaflet that comes with your medicine. Medicines give temporary relief but they won’t reverse the condition or prevent it from getting worse.

If you have a bunion as a result of underlying arthritis, your GP may prescribe specific medicines to treat this.

Surgery

If other treatments don’t help and your bunion is very painful, you may be referred to an orthopaedic or a podiatric surgeon for assessment. An orthopaedic surgeon is a doctor who identifies and surgically treats conditions affecting the bones, joints, muscles and ligaments. A podiatric surgeon is a health professional who specialises in the surgical treatment of feet.

There are over 130 different operations that can be carried out to treat bunions. Most of these procedures will aim to narrow your foot by straightening out your big toe joint as much as possible. An operation won’t return your foot back to normal, but most people find that surgery reduces their symptoms and improves the shape of their foot. The operation you have will depend on how severe your bunion is and whether or not you have arthritis.

One of the most common operations is called a metatarsal osteotomy. Your surgeon will cut one or more of the bones in your foot and then reset them so they are in line. He or she will also cut away the part of your big toe joint that is sticking out. Your surgeon may also correct the ligaments and tendons inside your foot by making them looser or tighter.

Another simpler operation that you may have is called an exostectomy (also sometimes called bunionectomy). In this procedure, your surgeon shaves off the part of the bone that is sticking out (ie the bunion). However, the bones aren’t straightened out. As this operation doesn’t correct the position of the bones, your bunion is more likely to return.

As with all surgery there are risks associated with these procedures. It’s likely that you will find the condition is much improved, but you may still have some pain and your big toe may feel stiffer. It’s also possible that in time the bunion will develop again.

For more information on bunion surgery, see Related topics.

Prevention of bunions

Wearing tight, high-heeled shoes may make bunions worse. You can ask an orthopaedic surgeon or podiatrist for advice about your footwear. He or she will probably advise:

• making sure that the toe of your shoe is wide enough to prevent your toes from being forced together – the widest part of your foot should be in the widest section of your shoe
• choosing shoes with a low heel and a wide toe box where you can wiggle your toes comfortably
• shoes with adjustable fastenings such as laces, buckles or straps that hold your feet inside your shoe
• using soft insoles in your shoes as shock absorbers

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.