A bunion (hallux valgus) is a painful bony bump on the inner side of the foot, where the big toe joint has drifted out of line [1]. If it is painless, or manageable with shoes and insoles, no operation is needed; surgery is for pain that continues despite these measures and clearly limits walking [1].
What is a bunion?
The first metatarsal bone shifts inwards and the big toe angles towards the second toe. The joint can become swollen and red; in severe cases the big toe can lie under or over the second toe and push neighbouring toes into hammer-toe deformities [1].
What causes it?
The main causes are narrow, pointed shoes, heredity (up to about 70% of people with bunions have a family history) and medical conditions such as rheumatoid arthritis or neuromuscular disorders [1].
Bunions are more common in women and usually develop in adulthood, although adolescent bunions occur in girls aged 10 to 15 [1].
What symptoms does it cause?
Pain and tenderness over the bump, redness, a corn or callus on it, hardened skin under the foot, and stiffness of the joint that can affect walking [1].
How is it diagnosed?
We examine the foot and the joint. Standing X-rays show the alignment of the toe and joint, any joint damage or arthritis, and how severe the bunion is, which guides the choice of treatment [1].
Non-surgical treatment
Shoes come first: a wide toe box, soft sole and good stability, and no heels higher than a couple of inches. Leave roughly 1 cm beyond the longest toe and try shoes on at the end of the day, when feet are widest [1].
Silicone pads reduce pressure; over-the-counter or custom insoles and toe spacers may help. Night splints ease pressure but do not correct the bunion permanently. Anti-inflammatory drugs such as ibuprofen or naproxen can reduce pain and swelling [1].
When is surgery considered?
Surgery is recommended when pain persists despite changes to footwear and non-surgical treatment, and clearly affects walking and daily function. A painless bunion that only bothers you cosmetically is not a reason for an operation [1].
The aim is to realign bones, ligaments and tendons to bring the big toe back into position. In open surgery the bump is removed, the bone is realigned (osteotomy) and held with screws or a plate; in minimally invasive surgery smaller incisions and one or two screws are used, with possibly less early swelling but similar long-term results, and it does not suit every bunion [1].
In adolescents surgery is reserved for severe pain that does not respond to other measures, because operating before the skeleton has matured risks the bunion coming back [1].
After surgery
Bunion surgery is usually a same-day procedure without a hospital stay, but recovery is long [1]. Possible problems include bursitis, ongoing pain and arthritis, deformities of neighbouring toes and recurrence [1].
When should you see a doctor?
See a doctor if pain limits your walking, if sores or calluses keep forming over the bump, or if the big toe is crossing over another toe [1].
Frequently asked questions
- Will shoes correct a bunion?
- Shoes and insoles reduce pain and pressure but do not reverse the drift of the bone; lasting correction is only possible with surgery [1].
- Does a night splint correct a bunion?
- No. A night splint eases pressure but does not permanently correct the bunion [1].
- Do I need surgery if it does not hurt?
- No. Surgery is only recommended for painful bunions [1].
- Will I have to stay in hospital?
- Bunion surgery is usually done as a day case, but recovery takes a long time [1].
- Is surgery done in children or teenagers?
- Only if pain is severe and nothing else helps, because operating before the skeleton has matured risks recurrence [1].
At our clinic we first ask how you walk, what you wear and where the pain limits you; we read the X-ray in the light of that conversation.
Sources
- Bunions. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
More in this area
- Achilles tendon rupture: surgery or a boot?
- Ankle sprain: when is an X-ray needed?
- Flat feet: do children outgrow them, and when are insoles or surgery needed?
- Foot pain: what causes it, what helps and which specialist to see?
- Broken foot and broken toe: symptoms and how long healing takes
- Ingrown toenail: what causes it, how does it heal, and when is a procedure needed?
- Heel spurs and plantar fasciitis: what causes heel pain and how does it settle?