What Are Bunions?
A bunion, medically referred to as hallux valgus, is a deformity of the big toe. The joint at the base of the big toe enlarges and protrudes, forcing the big toe to point inward toward the other toes. Typically, bunions begin as a bump or outward bend of the big toe that is only a cosmetic concern. However, the misaligned, outward-bending toe stretches the ligaments that connect the foot bones and pulls against the tendons, gradually drawing the toe farther out of line. Over time, the big toe continues to twist until it no longer lines up properly with its corresponding metatarsal and the end of the metatarsal may become enlarged. (Less frequently, a bunion can occur at the base of the fifth toe, when it is called a bunionette or a “tailor's bunion”.)
Shoes may exert pressure against the protruding joint, causing pain and irritation of the surrounding skin. Bunions are common and, while not serious, may be painful and limit the toe’s range of motion. Bunions are ten times more common among women than men.
Who Gets Bunions?
Bunions are one of the most common foot problems. They often run in families, which suggests that the inherited shape of the foot may predispose people to them. Women get bunions much more often than men. Improper shoes exacerbate the underlying cause of unstable flatfeet.
- A painful, bony lump at the side of the base of the big toe
- A big toe that points inward and possibly overlaps one or two toes
- Foot pain and stiffness that may interfere with walking and other activities
- Redness and swelling around the base of the big toe
Bunion Causes/Risk Factors
- Wearing shoes with pointed toes and high heels is the most common cause of painful bunions.
- Rheumatoid arthritis and osteoarthritis may lead to joint deformity and the development of bunions.
- The tendency to develop bunions may be partly inherited.
What If You Do Nothing?
Not only is a bunion painful, it also can become disfiguring. Neglecting bunions over a period of years can eventually interfere with standing and walking.
Physical examination and x-rays of the affected toe confirm the diagnosis.
Treatment for bunions requires a thorough evaluation by a podiatrist. Although the only way to eliminate bunions is by surgery, most people find relief through conservative treatments.
- To temporarily relieve pain and swelling, taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and applying ice to the foot 3 or 4 times a day may help. In addition, commercially available felt pads or cushions may ease pressure from the shoe on the bunion and the other toes. Around the house it may be helpful to wear an old shoe with a hole cut out above the bunion.
- Avoid wearing high-heeled shoes, especially those with pointed toes. Stretching your shoes may provide extra room and offer some relief. Also, make sure you are wearing the correct show size.
- Make sure your shoes are not too narrow. Stand barefoot on a piece of paper and have a family member or friend trace an outline of your foot. Then place your shoe on top of the outline—if your foot is wider than your shoe, which is often the case with people who have bunions—it's time to buy new shoes.
- Supports, or an orthotic shoe insert prescribed by your doctor, may help to redistribute weight on the foot.
- Stick to low-impact exercises like walking, water aerobics, or stationary biking, which will not aggravate the bunion as much as running or other high-impact activities.
- If a bunion causes severe discomfort, a surgical procedure called a bunionectomy may be performed. Surgical techniques vary, depending on the angle of the bones in the bunion and the extent of the deformity. The simplest procedure involves shaving the bump and repairing the soft tissue in the big toe joint.
- After surgery and recovery, the patient is fitted with orthotics to maintain stable, properly aligned feet. Without this treatment, the underlying cause of the bunion continues to cause problems and the bunion can recur.
Avoid high-heeled shoes whenever possible. Choose shoes with low heels and plenty of room for the toes.
When to Call Your Doctor
Make an appointment with a doctor if you experience continuing pain due to a bunion or if the bunion is interfering with walking or other activities.
Reviewed by Michael S. Soliman, M.D., family medicine physician in private practice and hospitalist at Mount Holyoke Medical Center, Mount Holyoke, MA.