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 happens when the bones of your big toe joint get out of line. This makes your big toe lean towards your second toe.
  2. Risk factors for bunions include having a family history of bunions, wearing tight, high-heeled or poorly fitted shoes, and some types of arthritis.
  3. Symptoms include a change in your foot shape, pain, redness and swelling.
  4. The symptoms of bunions are often relieved by simple self-care measures such as good footwear.
  5. Surgery can be done if your bunion gets more painful and affects your normal activities.

What causes a bunion? 

A bunion happens when the bones of your big toe joint get out of line. This makes your big toe lean towards your second toe. Your big toe joint then sticks out more and rubs against the inside of your shoes. This can damage the joint and the skin around it, causing it to become swollen 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 foot shape, such as flat feet or inward-rolling feet
  • foot injuries
  • wearing tight, high-heeled or narrow shoes – this is why bunions are more common in women or people who do activities such as ballet
  • certain type of arthritis such as rheumatoid arthritis and gout
  • other health conditions such as cerebral palsy and Marfan syndrome.

Comparison of foot with and without bunion

What are the symptoms of a bunion?

A bunion develops slowly. The main symptom of a bunion is a change in your foot shape, with the big toe bending towards the second toe. Your big toe becomes bigger and sticks out more.

Other symptoms include the following:

  • Worsening pain over the outer edge of your big toe joint.
    • This pain worsens when you wear tight shoes.
    • The more your foot shape changes, 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 of your big toe, which may make it difficult to walk

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 that 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 not usually needed.

How is a bunion treated?

Bunions can usually be treated with a few simple self-care measures (see 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 bring your bones back into line so that your big toe joint is put 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.

Publicly funded bunion surgery has limited availability, and eligibility depends on how badly your symptoms are affecting you. Private surgical treatment is an alternative option, which your GP can refer you for.

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 stop shoes rubbing. You can buy these from your 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 pharmacist or podiatrist if you need recommendations.
  • Ice the painful area – 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 always wear shoes that cover your whole foot (even indoors).
  • 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

Reviewed by

Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Alice Miller, FRNZCGP, Wellington Last reviewed: 16 Jun 2021