A bunion is a bony swelling at the base of the big toe.
The medical name for a bunion is hallux valgus.
Deciding whether to have bunion surgery
Surgical and non-surgical treatments
Complications of surgery
Structure of the foot
The foot is made up of five bones called the metatarsals that join the heel bone to the bones inside the toes. Normally, the big toe is in line with the first metatarsal, the second toe with the second metatarsal, and so on.
Sometimes, the big toe can become angled inwards, towards the middle of the foot and the second toe.
This can force the top of the first metatarsal to protrude (stick out) from the side of the foot, at the base of the big toe. If this happens, a painful, swollen bunion forms.
It is not known exactly why bunions occur, but wearing badly fitting shoes is thought to be a possible cause.
If bunions become worse over time, they can cause other problems, such as arthritis within the big toe joint.
Common treatments for bunions include:
- bunion pads, and, in severe cases,
Who gets bunions?
Anyone can develop a bunion, but they affect up to a third more women than men.
Symptoms of bunions
A bunion is a swollen, red, bony bump on the side of your foot, at the base of your big toe. Bunions are often painful, but sometimes they do not cause any pain at all.
If you have a bunion, you may also have these symptoms:
- Thick, rough skin over the bump, which may become broken and form ulcers.
- Pain when walking or wearing shoes, particularly if they are tight, pointed or have high heels.
- Tenderness and swelling around your big toe joint, which may be very hard to move. This is known as bursitis.
- Changes to the shape of your foot. As bunions form on the side of your foot, and often become worse over time, they can alter the overall shape of your foot.
If you have a bunion, you may notice that your big toe pushes inwards towards your other toes, or even begins to splay over, or under, your second toe. Your smaller toes may also become bent because there is less room for them inside your shoes.
A bunion can also increase the width of your foot where it protrudes (sticks out) at the side. This can make wearing shoes uncomfortable or painful, particularly if the bunion rubs on the inside of the shoe. Sometimes, your foot may become so wide that it is difficult to find shoes that fit at all.
Causes of bunions
Bunions occur when your big toe bends towards the middle of your foot and your second toe. This pushes the first metatarsal (the bone that is attached to your big toe) away from the second metatarsal so that it forms a bony lump on the side of your foot.
It is not known exactly what causes the big toe to bend in this way. However, family history and badly fitting shoes are two known risk factors that make developing bunions more likely.
If other members of your family have bunions, you are more likely to develop them yourself. This is because the bend of your big toe that causes bunions tends to run in families.
Badly fitting shoes
In many cases, bunions may develop as a result of wearing shoes that do not fit properly.
Women get bunions more often than men from wearing tight, pointed or high-heeled shoes. High heels push most of your body weight on to the front of your foot, placing a great strain on your toe joints.
If your shoes are too tight they rub against your big toe joint. Continuing to wear badly fitting shoes will make your bunions worse.
Bunions can also be caused, or made worse, by arthritis. Arthritis is a condition where the protective cartilage covering the joints becomes diseased or damaged. As the joints are stiff and hard to move, it can be difficult to straighten your toes to prevent them rubbing against your shoes.
Bunions get worse over time, so see your GP as soon as you develop one. It is very important to see your GP if a bunion is causing you pain or discomfort, or if you are having trouble finding footwear that fits.
Examining your foot
Your GP will examine your foot, and ask you about any symptoms that you have, such as pain and swelling. You may be asked to move your big toe up and down to see if your range of movement is limited.
Your GP may also ask you about the types of shoes that you wear, how frequently you wear them and whether you have recently made any footwear changes. You should tell your GP about any treatments that you have already tried for bunions, such as bunion pads or over-the-counter (OTC) painkillers.
Deciding whether to have bunion surgery
If you have bunions, deciding whether or not to have surgery will depend on your reasons for having surgery and what you expect it to achieve.
If you are very active and you play a lot of sport, being able to move your big toe freely may be more important to you than how it looks. Surgery can make your toes less flexible.
If you are thinking of having surgery so that you can wear different styles of shoe, remember that even after surgery there may still be limits to the styles that you can wear.
The success of your surgery will depend on the skill and experience of the surgeon or podiatrist (a specialist in foot care and conditions that affect the feet), the severity of your bunions, the type of surgery you have and your willingness, and ability, to rest after the operation. There are several potential pros and cons of surgery (see boxes on this page).
What happens if I don't have surgery?
The only way to get rid of a bunion completely is to operate. If you do not have an operation, your bunions will usually get bigger and hurt more. How fast this will happen and how bad they will become is difficult to calculate.
If you wait too long there is a danger that your other toes could be pushed out of alignment, in which case you willl need to have a more complex operation. This is why it is so important to discuss all the options with your surgeon, or podiatrist, before going ahead.
Which operation is best for me?
There is not any one particular procedure that is best for everyone. The anatomy of your foot and your big toe is incredibly complex. This is why it is important to be treated by a specialist in foot surgery, who can assess your problem in detail and decide upon the most suitable operation for you.
Surgical and non-surgical treatments
You may only need to have treatment for a bunion if it is causing you pain or discomfort. If your only problem is that you cannot find shoes to fit you, you may not need to have treatment, but your GP may be able to advise you about suitable footwear.
It is advisable for anyone with a bunion to wear flat or low-heeled, wide-fitting shoes. You may also find that shoes with laces or straps are preferable to slip-on shoes because they can be adjusted to fit (see Useful links).
Non-surgical treatments for bunions
There are various treatments that can be used to ease the pain and discomfort that is sometimes caused by a bunion. However, they cannot stop a bunion from becoming progressively worse over time.
If a bunion is causing you pain, your GP may suggest that you take a painkiller such as paracetamol or ibuprofen. When using painkillers, always take the recommended dose, and follow the guidance on the patient information leaflet that comes with the medicine to ensure that you do not take too much.
Do not take ibuprofen if you have asthma, high blood pressure (hypertension) or if you have stomach problems such as a peptic ulcer.
Bunion pads and ice packs
As well as taking painkillers, you may also be able to use bunion pads or ice packs to help ease the pain of a bunion.
Bunion pads are available over the counter from pharmacies. They come in reusable gel or fleece pad varieties. They may be adhesive and stick over the bunion, or be held against your foot by a small loop that fits over your big toe.
Bunion pads can be effective in protecting your foot from shoe rubbing, and relieving the pressure over the enlarged joint at the base of your big toe. You can also use an ice pack or cold compress to numb pain and reduce swelling.
Orthoses are devices that are used to improve and realign the bones of your foot. They may also be effective at easing the pain that is caused by bunions. Your GP may recommend that you use an orthotic if they think that you may benefit from it. There are several different types of orthoses, including special insoles for your shoes to correct the movement of your foot when you walk.
You may also want to try using special bunion splints, which are worn over the top of your foot and your big toe in order to help straighten its alignment. Splints are available for both daytime and nighttime wear.
Surgery for bunions
Surgery is the only way to correct your bunion. Your GP may refer you to be assessed for bunion surgery if a bunion is causing you severe pain.
Surgery is not usually carried out for cosmetic reasons only (to improve the appearance of your foot). As well as improving the alignment of your big toe, bunion surgery is also used to help relieve pain.
Surgery is successful for 85-90% of people who have it. However, there is no guarantee that your foot will be perfectly straight, or pain free, after the operation.
There are several complications that can occur after bunion surgery. These include:
- stiffness in the joints of your toes
- pain under the ball of your foot
- damage to the nerves in your foot
- the bunion re-occurring (coming back).
If you need to have bunion surgery, it will be carried out under either local anaesthetic (you will be awake, but your foot will be numbed) or general anaesthetic (you will be asleep). Bunion surgery is usually performed as a day case procedure, so it is unlikely you will have to stay overnight in hospital.
During the surgery, your surgeon will remove the bony growth and realign the bones inside your big toe. As part of your recovery after bunion surgery, you will need to wear wide-fitting, low-heeled shoes for approximately six months.
Complications of surgery
The risks associated with bunion surgery depend on the type of operation you have.
Possible complications are:
- Recurrence of your bunion.
- Poor alignment of the bones in your toe.
- Joint stiffness.
- Pain in other parts of the joint as a result of the weight being transferred to other parts of the foot.
- Fractured or broken bone (this is more likely if you try to do too much too soon).
- Non-union of bone (the bones do not knit together).
- Nerve damage leading to a loss of sensation.
- Numbness, tingling or burning.
Below is a list of general complications of foot surgery.
- Prolonged swelling.
- Continued pain.
- Infection in the soft tissue (or bone) of your foot (this can affect 1-5% of foot surgery patients).
- Deep vein thrombosis (blood clotting in the vein).
- Delayed healing (this can occur as a result of a damaged or poor blood supply, or from doing too much too soon. Bones also take longer to heal in smokers).
- Thickened scarring.
- Screw or pin movement.
- Chronic pain syndrome (continued pain as a result of the nerves failing to switch off pain signals). If this happens, you may be referred to a pain clinic.
- Further surgery may be needed.
You can minimise your chances of developing a bunion by wearing shoes that fit properly. Your shoes should be wide enough for your toes not to be forced together, and there should be enough room to move your toes (see Useful links).
Having your feet properly measured is useful because many people find they are wearing shoes that are the wrong size.
You may also want to visit a podiatrist who will examine your feet and give you advice about suitable footwear.