Bunions (Hallux Valgus)
Pressure from the way you walk or your foot shape can cause a bunion, a painful bony lump on the outside of the big toe. Narrow shoes and standing for long periods can make bunion pain worse. If bunion pads, toe spacers and better-fitting shoes don’t help, you may need surgery (a bunionectomy).
What is a bunion?
A bunion is a bump that forms on the outside of the big toe. This foot deformity occurs from years of pressure on the big toe joint (the metatarsophalangeal, or MTP, joint). Eventually, the toe joint gets out of alignment, and a bony bump forms. The medical term for bunions is hallux abducto valgus.
Who might get a bunion?
Up to 1 in 3 Americans have bunions. The foot problem is more common in older adults, especially women. Bunions can form on one or both feet.
What are the types of bunions?
Bunions on the big toe are the most common. Other types include:
- Congenital hallux valgus: Some babies are born with bunions.
- Juvenile or adolescent hallux valgus: Tweens and teens between the ages of 10 and 15 may develop bunions.
- Tailor’s bunion: Also called a bunionette, this bunion forms on the outside base of the little (pinky) toe.
What causes bunions?
Pressure from the way you walk (foot mechanics) or the shape of your foot (foot structure) causes your big toe to bend in toward the second toe. Bunions happen gradually over time. Standing for long periods and wearing ill-fitting, narrow shoes can make bunion pain worse, but they don’t cause the problem.
What are the risk factors for bunions?
You may be more likely to get a bunion if you have:
- Family history of bunions due to inherited foot structure problems, like flatfeet.
- Foot injuries.
- Inflammatory diseases, such as rheumatoid arthritis.
What are the signs of bunions?
A bunion resembles a turnip — red and swollen. In fact, some sources say the word bunion comes from the Greek word for turnip. Other symptoms include:
- Inability to bend the big toe, or pain and burning when you try to bend it.
- Difficulty wearing regular shoes.
- Corns or calluses (thickened skin).
- Hammertoes (painful, tight toe tendons and joints).
- Numbness in the big toe.
How are bunions diagnosed?
Your healthcare provider can diagnose a bunion by looking at it. You may also get X-rays to check for joint damage and bone alignment.
How are bunions managed or treated?
Bunions don’t go away. Treatment often focuses on relieving symptoms and may include:
- Bunion pads and taping: Over-the-counter bunion pads can cushion the area and ease pain. You can also use medical tape to keep the foot in the correct position.
- Footwear changes: Switching to shoes with wide, deep toe boxes can take pressure off of your toes. You may be able to use a stretching device to widen shoes you already own.
- Orthotic devices: Over-the-counter or custom-made shoe inserts (orthotics) can help to control alignment issues such as pronation that may be contributing to bunion formation. You can also place a spacer between the big toe and second digit. Some people find relief by wearing a splint at night to keep the big toe straight.
- Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) both oral and topical can be combined with ice packs help with pain and swelling.
- Physical therapy: Massage, physical therapy and ultrasound therapy can break up soft-tissue adhesions to reduce pain and inflammation. There are actually exercises that can help improve muscle strength around the bunion and can modestly improve alignment.
- Injections: Steroid injections may reduce pain and swelling but may also be damaging if used too often or injected into the joint itself. This is often a late treatment of bunions when trying to avoid surgery.
- Surgery:If nonsurgical treatments don’t help, and walking becomes extremely painful, your provider may recommend surgery. This procedure is called a bunionectomy. Your provider removes the bunion and realigns bones to bring the big toe back into the correct position.
How can I prevent a bunion?
Proper-fitting footwear is key to preventing bunions or keeping an existing bunion from getting worse. Your healthcare provider can offer tips on how to select appropriate shoes. In general, you should buy shoes with a wide toe box and soft soles. Avoid shoes that are narrow and pointed at the tip, and high heels that put pressure on the front of the foot. If you have flatfeet or another inherited structural foot problem, custom-fitted orthotics can help prevent, or slow the progression of, bunions.
What are the complications of bunions?
Having a bunion may increase your risk of:
- Bone spurs.
- Bursitis (painful, fluid-filled sacs around joints).
What is the prognosis (outlook) for people with bunions?
Without the right care, like changing your footwear or using orthotics, bunions can get worse over time. If you have severe pain when you walk or stand, you may become sedentary (inactive), which isn’t good for your health or quality of life. Most people get symptom relief with over-the-counter aids or through treatments at a medical office. If needed, surgery can help.