Bunions

A bunion, also known as hallux valgus, is when your big toe turns towards your other toes. The joint in your big toe deforms, which causes a bony lump on the side of your foot. Skin in this area can thicken, in response to rubbing against your shoes, and tissues can become inflamed. This causes pain and swelling. 

Sometimes a soft swelling will develop over the lump called bursitis. Sometimes a smaller bunion can appear on your little toe called a bunionette.

In most cases, it may not be obvious why a bunion has formed, but certain things increase your risk of getting them including:

• Activities such as rock climbing or ballet
• Being a woman
• Family history of bunions
• Foot abnormalities
• Joint problems such as osteoarthritis or rheumatoid arthritis
• Wearing tight-fitting or high heeled shoes

If you have a bunion, you may notice:

• Difficulty finding shoes that fit and are comfortable
• Difficulty moving your toe or foot
• Foot pain — including pain caused by increased pressure on the ball of your foot (metatarsalgia)
• Hard lumps at the base of your big toe
• Red and sore skin over the lump
• Your big toe pointing at your other toes

You might also: 

• Develop arthritis in your big toe
• Develop corns or calluses around your big toe
• Develop a deformity in your second toe
• Notice your big toe is pushing your second toe upwards

Although bunions often need no medical treatment, see your GP or a doctor who specialises in treating foot disorders (podiatrist or orthopaedic foot specialist) if you have:

• A visible bump on your big toe joint
• Decreased movement of your big toe or foot
• Diabetes — foot problems are usually worse in people with diabetes
• Difficulty finding shoes that fit properly because of a bunion
• Noticed your bunions getting worse
• Persistent pain in your big toe or foot 

Usually, your doctor can tell you if you have a bunion after conducting a simple assessment. They'll look at your feet and toes and watch you walk.

An X-ray can show the level of deformity.

Bunions can cause other conditions to develop, including: 

• Bursitis — inflammation of small, fluid-filled sacs (bursae) in your joints
• Hammertoe — an abnormal bend in the middle joint of a toe; this usually occurs in your second toe and causes pain and pressure
• Metatarsalgia — pain and swelling in the ball of your foot

Your GP may refer you to a podiatrist to give you advice on how to manage your bunions. If you have bunion pain, this can be eased by:

• Applying ice packs if your bunion is inflamed, sore or swollen, or if you've been on your feet for a long time — if you have circulation problems or reduced feeling in your feet, get advice from your doctor before applying ice packs
• Losing weight
• Taking over the counter painkillers eg ibuprofen or paracetamol 
• Using bunion pads to stop shoes rubbing against your toes
• Using insoles or bunion correctors (splints) — these spread the pressure more evenly across your foot to help prevent your bunion getting worse; if these are not effective, you can speak to your doctor about getting prescription orthotics 
• Wearing flat, wide, well-fitting shoes that give your toes more space and avoiding high-heeled, tight, pointy shoes — shoes with laces or straps are best as they allow you to more easily adjust the fit of your shoes to accommodate your bunion

If your bunions are very painful or are reducing your quality of life, your GP may recommend a surgery called a bunionectomy or an osteotomy. This will straighten out the joint in your big toe as much as possible and consequently improve the appearance of your big toe and reduce your pain. Surgery is usually a day case and can be performed under local or general anaesthetic. It is the only way to get rid of bunions. 

Bunion surgery can involve removing, realigning and pinning of your bones to:

• Correct the deformity
• Narrow your foot
• Straighten your toes

A common type of bunion surgery is a scarf osteotomy, which refers to the shape of the bone cut used by the surgeon. Bunion surgery can be used to: 

• Completely replace the big toe joint with an artificial joint
• Fuse the joint so it cannot move (arthrodesis)
• Trim parts of the joint

Risks of bunion surgery include: 

• Not being able to fully straighten your big toe
• Stiffer or weaker toes
• Still experiencing some bunion pain
• Your bunions returning
• Your feet still being a little wide — you will likely need to wear wide, comfortable shoes even after surgery

It takes several weeks to recover from bunion surgery. During your recovery, it is recommended that you:

• Stay off your feet as much as possible for the first two weeks
• Avoid driving for six to eight weeks
• Take leave from work for six to 12 weeks
• Avoid sports for up to six months

As the cause of bunions is usually not known, you may not be able to prevent bunions developing. However, you can reduce your risk by: 

• Avoiding high-heeled, pointy and/or tight shoes
• Wearing shoes that are the right size and have a good amount of space for your toes