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Bunions

A bunion is a painful lump that can develop on the side of your foot and affect how you walk. Wearing ill-fitting shoes can contribute to bunions forming because they put a strain on the bones and muscles in your feet. Bunions are the most common forefoot problem in adults and are much more common in women than men.

Image showing a bunion in the right foot

About bunions

The first sign that a bunion is developing is when your big toe starts to angle towards your second toe.

Doctors may use the medical term ‘hallux valgus’ to describe the turning of your big toe combined with a bunion. ‘Hallux’ means your big toe. ‘Valgus’ means that it’s pointing towards the other toes on that foot. Your big toe may also turn so that the toenail is facing your other foot, rather than upwards. As your big toe bends towards the other toes, the bone at its base gets pushed out to the side. It then sticks out and rubs on your shoe.

Symptoms of bunions

Some people don’t get any symptoms from bunions but if you do, they may include:

  • pain in your big toe joint
  • a swollen big toe

These symptoms can make it difficult to walk and lead to pain in the ball of your foot. You might also find that your shoes don’t fit properly.

Sometimes, the skin over the bunion can become red, blistered or infected because it has been rubbing against your shoe. A fluid-filled space called a bursa may also develop under your skin. This can be painful if it swells up (bursitis).

These symptoms may be caused by problems other than bunions. If you have any of them, make an appointment to see a podiatrist or chiropodist. These are healthcare professionals who specialise in conditions that affect the feet. The term ‘chiropodist’ isn’t widely used anymore. Your GP may be able to refer you to a podiatrist or you can see one privately. See our FAQ on podiatrists below for more information.

Diagnosis of bunions 

Your podiatrist will diagnose your bunion by asking about your symptoms. They’ll also examine your feet and may ask you to walk around so they can see how the bunion affects the way you walk.

You may have blood tests to rule out other medical conditions such as rheumatoid arthritis or gout.

If you need to have surgery, you might have further tests such as:


Self-help

If you have a bunion, one of the most important things you can do is to wear the right footwear. Try to resist any temptation to wear high heels because they can make a bunion worse. High heels push your foot forwards in your shoe and shoes that are too narrow in the front squeeze your toes together. Choose shoes with a heel less than two inches (five centimetres) high and wide enough at the front not to cramp your toes. It’s very important that your shoes fit properly.

It might help to put a bunion pad over the area to give it some protection from the pressure of your shoes. You can usually buy these pads from a pharmacy or get them from your podiatrist. Your podiatrist may also recommend a shoe insert, which can be moulded specifically to your foot.

If your bunion is painful and swollen, you might find it helps to put ice on it – a bag of frozen peas works fine. Take care not to put any ice directly onto your skin because ice can damage your skin – so wrap whatever you use in a towel.

Treatment of bunions

Wearing appropriate shoes, using shoe inserts (orthoses or orthotics) and padding, and taking painkillers may help to ease the symptoms of a bunion. But they won’t always stop your bunion from getting worse. If you have severe pain from a bunion, you might need to have an operation to correct it.

Medicines

You can take over-the-counter medicines, such as paracetamol or ibuprofen, to help relieve pain and swelling from a bunion. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If you have a bunion caused by arthritis, your GP may prescribe medicines to treat this. For example, your GP may recommend you have a steroid injection into your toe joint. This may also be an option if you don’t have arthritis but have severe pain from a bunion.

Surgery

If you’ve tried all the non-surgical treatments but they haven’t helped, you may want to think about surgery. Your GP may refer you to see an orthopaedic or a podiatric surgeon to see if this is an option for you. However, your GP can only refer you for surgery under the NHS if:

  • your bunion is really painful and is getting worse
  • your second toe is also affected by the bunion
  • you have difficulty finding any shoes to fit and the bunion is severely affecting your day-to-day life

If you want to have surgery because of how your bunion looks, you’ll need to have this done privately. However, surgery is not recommended solely for cosmetic reasons because there can be complications.

Surgery to correct a bunion is called a bunionectomy. There are many different types of this operation. The simplest just removes the bit of bone that is sticking out. More complicated operations aim to correct the alignment of your big toe. This narrows your foot and straightens out your big toe joint as much as possible. An operation won’t return your foot to normal but most people find it reduces their symptoms and improves the shape of their foot. It’s important to make sure you wear sensible shoes even after your operation.

The type of operation you have will depend on how severe your bunion is and whether or not you have arthritis.

You can read more about bunion surgery, including information on how long it takes to recover and when you can walk again.

Causes of bunions 

 Doctors don’t know exactly what causes bunions, but things that can increase your risk of developing them include the following.

  • The way you walk, for example if your foot rolls inwards. Over time, this can lead to a bunion forming.
  • Bunions can run in families, but just because your parents or grandparents have bunions doesn’t mean you’ll necessarily develop them too. 
  • The type of shoes you wear may affect whether or not you get a bunion. Narrow or high-heeled shoes can put extra strain on the bones and muscles in your foot and push your toes together. Wearing poorly fitting shoes doesn’t cause bunions on its own but it can make them worse.
  • You’re much more likely to get bunions if you’re a woman. This may be from wearing tighter footwear and high heels, or because the ligaments in your feet (the structures that connect bones together) are looser in women.
  • Bunions are sometimes associated with conditions that affect your joints, such as rheumatoid arthritis.
  • Other health conditions that are associated with bunions include gout, stroke or a foot injury.

Prevention of bunions 

You can reduce your risk of getting a bunion by wearing the right type of shoes and boots. Ask your podiatrist for advice about footwear. They’ll probably advise you choose shoes:

  • that are wide enough, so there isn’t any pressure on the joints at the sides of your feet and you can wiggle your toes comfortably
  • with a heel lower than two inches (five centimetres), so your feet aren’t pushed forwards
  • with adjustable fastenings, such as laces, buckles or straps, that hold your feet comfortably inside your shoe

They may also suggest you use shoe inserts (orthotics or orthoses) to correct your walking if you have problems.

FAQ: Will a bunion cause osteoarthritis in my big toe?

Not everyone with a bunion develops osteoarthritis. However, any movement of your big toe inwards may mean you’re more at risk of developing the condition.

Osteoarthritis in your big toe, can develop in some people who have bunions. It can also happen the other way around – if you have osteoarthritis in your toe, it can lead to a bunion developing. Your toe joint is more prone to osteoarthritis than any other joint in your foot. This is because of the repeated pressure you put on it when you walk.

Osteoarthritis is a condition that affects your joints and makes them stiff and painful. It causes the cartilage on the end of your bones to get rougher and thinner. The bone beneath reacts by thickening and growing outwards, and can create bony outgrowths called spurs. These make your joint look misshapen and knobbly.

The joints that tend to be most affected by osteoarthritis are your knees, hips and hands. As well as bunions there are other things that can increase your risk of developing osteoarthritis, such as:

  • your age – osteoarthritis is more common in people over 45
  • your weight – being overweight increases your risk of osteoarthritis, and makes the condition worse once you have it
  • having a family history of osteoarthritis
  • a past injury to a joint

FAQ: What is a podiatrist and how can I find one?

A podiatrist is a health professional who treats conditions that affect your feet. They are sometimes called chiropodists – podiatrist and chiropodist mean the same thing, but the term ‘chiropodist’ is less frequently used nowadays.

A podiatrist is trained to treat people with health conditions like arthritis and diabetes, as well as sports injuries. Podiatrists can also diagnose and treat conditions such as ingrown toenails, corns and calluses, and infections including Athlete’s foot and verrucas. They can give advice on how to take care of your feet and recommend exercises, devices and shoe alterations that may help relieve your symptoms.

There are a number of ways you can get in touch with a podiatrist. Your GP may be able to recommend someone or you can contact the College of Podiatry. This institution represents practising podiatrists. It’s important to find a podiatrist or chiropodist who is a member of the Health and Care Professions Council (HCPC). This will ensure that you see a registered professional.

FAQ: How long until I can walk after bunion surgery?

The time it takes to recover from bunion surgery will depend on the type of operation you have had. You may have to wear a plaster cast, a brace or a protective shoe after some types of operation. With some operations, you can walk on your affected foot immediately. With others, you need to keep weight off your foot for up to eight weeks. You can use crutches during this time.

It usually takes three to six months to recover fully, but this will vary. One person may feel no pain and recover very quickly, whereas another may be in discomfort and take a long time to heal. It depends on your individual circumstances. With some types of surgery, you may have to wear surgical shoes for six months to allow your bones to fully heal.

When you can return to work will also depend on the type of operation you have had. Another important thing to think about is how much time you spend on your feet doing your job. If you have a sedentary job, you may need to take up to six weeks off work. If your job is very physical, you might need up to three months off. Your surgeon can give you more advice about this.

FAQ: Can I get a bunion on my little toe?

Yes, although these are less common than bunions of the big toe. If a bunion forms on the outside of your foot, below your little toe, it’s known as a bunionette or a tailor’s bunion.

A bunionette can be treated in the same way as a bunion of the big toe. If you have a bunion at the base of your little toe which is causing you discomfort or pain, there are some things you can try to ease your symptoms. Try taking over-the-counter painkillers like paracetamol or ibuprofen, wearing suitable shoes, or using bunion pads. If your symptoms don’t get any better, you may need to be considered for surgery, so make an appointment to see your GP or a podiatrist.  

Details

  • Bunion treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including bunion treatment.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Hallux valgus. BMJ Best Practice. bestpractice.bmj.com, last updated April 2014
    • Hallux valgus. British Orthopaedic Foot & Ankle Society. bofas.org.uk, accessed August 2017
    • Bunions. NICE Clinical Knowledge Summary. cks.nice.org.uk, last revised August 2016
    • Bunions. The American College of Foot and Ankle Orthopedics and Medicine. acfaom.org, accessed August 2017
    • Hallux valgus. PatientPlus. patient.info/patientplus, last checked November 2016
    • Foot Health. The College of Podiatry. scpod.org, accessed August 2017
    • Bunion Workup. Medscape. emedicine.medscape.com, updated April 2016
    • Bunions. American Academy of Orthopaedic Surgeons. orthoinfo.aaos.org, last reviewed February 2016
    • Osteoarthritis. National Institute of Health and Clinical Evidence (NICE). February 2014. nice.org.uk
    • Bunions. The College of Podiatry. scpod.org, accessed August 2017
    • Bunion Surgery. American Academy of Orthopaedic Surgeons. orthoinfo.aaos.org, last reviewed February 2016
    • Osteoarthritis. The College of Podiatry. scpod.org, accessed August 2017
    • Arthritis of the Foot and Ankle. American Academy of Orthopaedic Surgeons. orthoinfo.aaos.org, last reviewed March 2015
    • Osteoarthritis. NICE Clinical Knowledge Summary. cks.nice.org.uk, last revised August 2016
    • Osteoarthritis. PatientPlus. patient.info/patientplus, last checked March 2017
    • How a Podiatrist can help. The College of Podiatry. scpod.org, accessed August 2017
    • Hallux Valgus Treatment & Management. Medscape. emedicine.medscape.com, updated July 2016
    • Bunions. American Orthopaedic Foot and Ankle Society. aofas.org, accessed August 2017
    • Commissioning guide: painful deformed great toe in adults. Royal College of Surgeons of England. www.scpod.org, published November 2013
    • What is podiatry? The College of Podiatry. scpod.org, accessed October 2017
    • Bunionette. Medscape. emedicine.medscape.com, updated April 2016
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    Reviewed by Michelle Harrison, Specialist Health Editor, Bupa Health Content Team, November 2017
    Expert reviewer, Mr Ian Reilly, Consultant Podiatric Surgeon
    Next review due November 2020

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