Bunions

A bunion is a bony lump on the side of your foot, at the base of your big toe. It develops when your big toe moves towards your other toes, and the bone below moves outwards. A bunion can rub against your shoe and become sore, especially when you walk.

What is a bunion?

A bunion (hallux valgus) affects your big toe joint at the front of the foot. You may first notice that you have a bunion when your big toe starts to bend towards your second toe. The bone at the base of the big toe gets pushed to the side and sticks out. This causes the bunion, which can be painful and may affect the way you walk (also called your gait).

Bunions are the most common problems to affect the front part of the foot in adults.

Causes of bunions

Doctors don’t know exactly what causes bunions, but some things can give you a higher chance of getting one.

• If your shoes don’t fit well and are too small or too tight, or you often wear high heels, you might have a higher chance of getting a bunion.
• Bunions can run in families.
• If you’re ‘flat-footed’, you’re more likely to get a bunion. This is when the arches of your feet are flatter than they should be because your arches have dropped.
• If you have a long-term condition that affects your joints – for example, rheumatoid arthritis or gout – you may be more likely to get a bunion.
• Anything that affects how you walk – for example, a foot injury, stroke or multiple sclerosis can make you more likely to have a bunion.
• Bunions are more common in women.
• Getting older raises your risk of having a bunion, because of the way age affects your joint movement.

Symptoms of bunions

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

• a red or swollen big toe
• pain in the joints of your toes, especially when you walk

Your bunion may get bigger and feel more painful over time. You may find it harder to walk due to the pain. A bunion can also affect your balance and increase your chances of a fall. It may be hard to find comfortable shoes.

Sometimes, the skin over your bunion can get red, blistered, or infected because it rubs against your shoe. A fluid-filled space called a bursa may form under your skin. This can be painful if it swells up (this is called bursitis).

If you have any of these symptoms of a bunion, see your GP. They may be able to refer you to a podiatrist (a healthcare professional who specialises in foot conditions). Alternatively, you can see a podiatrist privately. These symptoms can be caused by problems other than bunions, so it’s important to get them checked out.

Diagnosis of bunions

The GP or 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 need to have blood tests to rule out other health conditions – for example, rheumatoid arthritis or gout.

If you need to have bunion surgery, you may have further tests such as an X-ray.

Self-help for bunions

There are ways to ease the symptoms of bunions yourself. But there is no way to shrink a bunion naturally.

Footwear

One of the most important things you can do if you have a bunion is to wear the right footwear. Try not to wear high heels. Instead, wear shoes with a low heel, a wide front, and a thick, soft sole. Make sure your shoes have a back strap support. Backless shoes force your toes to claw as you walk. Over time, this can strain your muscles.

Padding and splints

If you put a bunion pad over the bony lump, it may protect your feet from the pressure of your shoes. You can buy these pads from a pharmacy or from a podiatrist.

There are splints that you can wear at night to ease the pain from a bunion.

Shoe inserts

A podiatrist may recommend shoe inserts (orthoses or orthotics), which can be designed specifically for your foot.

Ice

If your bunion is painful and swollen, you can put something frozen on it. A bag of frozen peas is ideal, but don’t leave it on any longer than 10 minutes at a time. And don’t put ice directly onto your skin, because ice can damage skin – wrap the ice in a towel first. If you have diabetes or poor blood flow to your feet, speak to a GP or podiatrist first.

Exercises

Weak muscles in your foot and leg may affect bunion-related pain and movement problems. There are exercises you can do each day that may strengthen your muscles and ease the symptoms of bunions. There isn’t any evidence to prove these exercises work, but if you decide to try them, it may help to combine them with other self-help methods. More research is needed to know for sure.

Do all these exercises barefoot, and hold each stretch for 5 seconds. Keep going until you feel the muscles getting tired. You can start doing them sitting down in a chair before you progress to standing up and eventually balancing on one leg.

• Try to shorten your foot while you keep your heel and the front of your foot on the ground, but don’t curl your toes.
• Lift and spread your toes while you keep your heel and the front of your foot on the ground. While your toes are spread out, push your little toe down and out. Then push your big toe down towards the inside of your foot.
• Stand with your knees bent, then raise your arch while you keep your heel turned in. Then raise your heel off the floor while you keep pressure on your big toe.

Treatment of bunions

The self-help measures above will help to ease the symptoms of a bunion, but they won’t stop your bunion from getting worse over time. If your bunion causes severe pain, only an operation can correct it.

Medicines

You can take over-the-counter painkillers such as paracetamol or ibuprofen, to ease any pain and swelling caused by a bunion. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask a pharmacist for advice.

If your bunion is caused by arthritis, a 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 your bunion is red and swollen (inflamed).

Surgery

If you’ve tried self-help measures and medicines but they haven’t helped, bunion surgery may be needed. A GP may refer you to an orthopaedic or a podiatric surgeon to see if this is an option for you. A GP can refer you for bunion surgery under the NHS only if:

• your bunion is very painful and getting worse
• your second toe is also affected by the bunion
• you’re struggling to find any shoes that fit
• the bunion is badly affecting your day-to-day life
• you still have symptoms after trying self-help measures, shoe modifications, and medicines for three months

If you want to have surgery because of how your bunion looks, you’ll need to have private treatment. Surgery isn’t recommended just to make your foot look better because it can cause complications.

There are numerous types of bunion surgery. Simple surgery will reduce the lump on your foot, while more complicated surgery may also make your big toe as straight as possible. The best type of surgery for you will depend on how bad your bunion is, your lifestyle, and if you have arthritis.

An operation aims to return your foot to normal and realign the big toe joint. A bunion is a complex deformity, and surgery aims to address all of the factors, realign the big toe joint, and resolve the pain. You may need to wear a modified shoe after your operation to protect your foot.