Bunions

Also known as hallux valgus

A bunion is a painful bony lump that forms at the base of your big toe.

Key points about bunions

  1. A bunion forms when the bones of your big toe joint get out of alignment. This makes your big toe lean towards your second toe.
  2. Risk factors for bunions include genetics, injuries, wearing tight, high-heeled or poorly fitted shoes and some health conditions such as rheumatoid arthritis and gout.
  3. Symptoms include a change in your foot shape as your big toe leans towards your second toe, as well as pain, redness and swelling.
  4. Treatment consists of self-care measures and surgery if your bunion gets more painful and affects your normal activities.
See your GP or podiatrist to get your feet checked if you experience the following:
  • the pain over the outer edge of your big toe joint is getting worse
  • pain that stops you from carrying out your normal activities
  • your pain doesn’t improve after trying self-care measures
  • calluses and corns start to develop
  • changes in the colour of your skin
  • you have diabetes or any condition reducing the circulation to your feet and any symptoms above.

What are the causes of a bunion? 

A bunion forms when the bones forming your big toe joint get out of alignment. This causes your big toe to lean towards your second toe. Your big toe joint becomes more prominent and rubs against the inside of your shoes. This can damage the joint and the skin around it, causing it to become enlarged and painful.

The exact cause of a bunion developing isn't clear, but there are a number of risk factors that may contribute. These include:

  • genetics – if one of your parents has bunions, your risk is higher
  • people born with abnormal feet such as flat feet or inward-rolling feet
  • foot injuries
  • lifestyle – wearing tight, high-heeled or narrow shoes, eg, this more commonly occurs in women or in people who do activities such as ballet
  • certain type of arthritis such as rheumatoid arthritis and gout
  • other conditions such as cerebral palsy and Marfan syndrome.

Comparison of foot with and without bunion

What are the symptoms of a bunion?

A bunion develop slowly. The main symptom of a bunion is a change in your foot shape, with the big toe bending towards the second toe and your big toe joint becoming enlarged and more prominent.

Other symptoms include the following:

  • Increasing pain over the outer edge of your big toe joint.
    • This pain worsens when you wear tight shoes.
    • The more your toes become more displaced, the more difficult it becomes to find shoes that fit comfortably.
  • Red or swollen skin around your big toe joint.
  • Thickening of the skin at the base of your big toe.
  • Stiffness and restricted movement of your big toe, causing walking difficulty.

You may get corns and calluses where your big toe overlaps with your second toe. You may also get ingrown toenails.

See your GP or podiatrist to get your feet checked if you experience the following:
  • pain over the outer edge of your big toe joint is getting worse
  • pain that stops you from carrying out your normal activities
  • your pain doesn’t improve after trying self-care measures
  • calluses and corns start to develop
  • changes in the colour of your skin
  • you have diabetes or any condition reducing the circulation to your feet and any symptoms above.

How is a bunion diagnosed? 

To diagnose bunions, your doctor or podiatrist will ask about your symptoms and examine your feet. X-rays and special tests are rarely needed.

How is a bunion treated?

Treatment consists of self-care measures and surgery. Surgery is needed when your bunion is getting more painful and affects your normal daily activities.

A bunion develops slowly, so you can reduce your symptoms with self-care measures such as those described below.

If your bunion gets worse and more painful, your GP or podiatrist may refer you to a surgeon to assess if surgery would help. Surgery can realign your bones so that your big toe joint is brought back to the correct position. There are a range of operations to realign your toe. Your surgeon will discuss the best treatment options for you and the possible risks of different operations.

How can I care for myself with a bunion? 

There are things you can do to help reduce your symptoms.

  • Wear wide-toed, comfortable shoes.
  • Don’t wear high heeled or tight pointy shoes as they can make your bunion worse.
  • Try foam pads or bunion pads – placing a pad on the side of your big toe can help cushion the pressure and reduce shoe friction. You can buy these from your local pharmacy.
  • Wear orthotics, spacers and shoe inserts – these devices provide a gap between the first and second toes. ou can buy these from your local pharmacy and some shoe stores. Ask your GP or podiatrist if you need recommendations.
  • Ice the painful area – if your feet are painful and uncomfortable, applying an ice pack can reduce the inflammation and discomfort.
  • Jandals and bare feet can be more comfortable if safe to do so, such as around your home. If you have diabetes, you should wear footwear at all times to protect your feet.
  • Avoid activities that can make the pain worse, such as ballet and running.
  • Pain relief medicines such as paracetamol and ibuprofen can be taken if necessary. Ask your GP or pharmacist for advice.

What support is available with a bunion? 

A podiatrist can help assess your foot and advise the best treatment options for you. You can find a local podiatrist on the Podiatry NZ website.

Learn more

Bunions HealthInfo Canterbury, NZ
Bunions NHS, UK
Bunions Patient Info, UK
Bunions OrthoInfo, US
Bunions American College of Foot & Ankle Surgeons, US

References

  1. Bunions (hallux valgus) Auckland Regional HealthPathways, NZ, 2018
  2. Hallux valgus Patient Info, UK
  3. Hecht PJ, Lin TJ. Hallux valgus. Med Clin North Am. 2014 Mar;98(2):227-32.
  4. Hallux valgus and bunion surgery Wheeless' Textbook of Orthopaedics
Credits: Health Navigator Editorial Team.