Also known as hallux valgus, this happens because of a problem with the structure of the bone in the foot and toes, usually the metatarsophalangeal (MTP) joint. As a result of this, the feet no longer line up properly.
It usually affects the bone of the big toe, which inclines toward the second toe, instead of straight ahead.
As the big toe pushes against the neighboring toe, this causes the joint to stick out.
The symptoms of bunions often affect adults, but adolescents can experience them, too.
They are thought to happen because of an inherent problem with the bones of the foot. Some people have hallus valgus but never develop symptoms. Shoes that crowd the toes can make symptoms more likely, but they do not cause bunions.
Bunions can also occur near the base of the little toe instead of the big toe. These are known as bunionettes or "tailor's bunion."
Here are some key points about bunions. More detail and supporting information is in the main article.
- Bunions are also referred to as hallux valgus or hallux abducto valgus.
- The bony lump develops when a toe pushes against a neighboring toe. This alignment causes the joint to protrude.
- Bunions are more common in women than in men.
- Adolescent bunions develop most often in girls ages 10 to 15 years.
- People can often relieve bunion pain by wearing more comfortable shoes and relieving pressure on the toe.
Causes and risk factors
Bunions are bony bumps that often form at the base of the big toe.
The bone structure that causes bunions to develop is thought to be inherited.
Other factors then increase the chance of a bunion appearing.
- overpronation, having a low arch, or uneven weight-bearing in the foot or tendon that makes the toe joint unstable
- having a big toe bone that moves more than usual, known as hypermobility
- foot injuries
- forms of arthritis, such as rheumatoid arthritis
- conditions that affect both the nerves and muscles such as polio
If the feet do not develop properly before birth, this can also increase the risk.
There may also be a link between the use of high-heeled or narrow shoes and the growth of bunions.
Studies suggest that around 2 percent of children under the age of 10 years have this condition, and almost half of all adults.
Adolescent bunions are most likely to affect girls between the ages of 10 and 15 years. These usually run in families. The young person can usually move their toe up and down. In adults, movement is more likely to be restricted.
The classic symptom of a bunion is a bump that forms at the base of the big toe. These can also form at the base of the little toe, known as a "tailor's bunion" or bunionette.
Other symptoms of bunions may include:
- pain and soreness
- a burning sensation
- swelling at the joint of the affected toe
- increased skin thickness at the base of the affected toe
- hardened skin under the foot
- bump on the base of the affected toe
- the presence of corns or calluses
- movement restriction within the affected toe
Wearing narrow shoes or high heels or standing for a long time may worsen the symptoms.
Bunions begin as small lumps. They get worse over time, however, causing pain and making walking difficult.
The presence of bunions can lead to other conditions.
Wearing high-heeled or pointy-toed shoes can make bunion symptoms worse.
- swelling of the fluid-filled pads responsible for cushioning the bones, tendons, and muscles (bursitis)
- hammertoe, where abnormal joint bending leads to pain and pressure
- swelling and pain in the ball of the foot (metatarsalgia)
- difficulty walking
- decreased toe mobility
Here are some pictures of bunions and some of the complications they can lead to.
Bunions can cause the toes to point inward toward the second toe, instead of straight.
Bunions result from an underlying bone deformation. Some people have this feature but do not develop symptoms.
Hammertoe is a possible complication of bunions. One toe can eventually cross over the other, causing pain and discomfort.
Metatarsalgia can result from bunions. The ball of the foot becomes swollen and painful.
People with bunions are more likely to have calluses, hard skin that accumulates in one area, causing pain.
A diagnosis is usually possible by looking at the bunion.
A healthcare provider can use physical examination and X-rays to diagnose the presence of bunions. An X-ray will show the doctor how severe the bunion is and help them decide what the best treatment will be.
The treatment of bunions depends on their severity. Bunions can often be treated without surgery.
Lifestyle adaptations to relieve bunions include:
- Appropriately fitting footwear: Shoes that have sufficient space inside can relieve pressure on the toe.
- Foot measuring: A good shoe shop will measure your feet and advise on suitable footwear options.
- Shoe inserts: Also known as orthotics, inserts relieve pressure on the toe. Orthotics are available for purchase online.
- Padding, taping, or splinting of the toe.
- Avoiding activities that increase pain: These include standing for a long period of time.
- Ice: Applying ice to the affected area can help reduce swelling.
Some bunions can be treated without surgery. Cortisone injections may help.
Medication can help with pain and swelling.
- Pain-relieving medications: Ibuprofen, for example, can reduce pain and swelling. They are available over-the-counter.
- Cortisone injections: These can relieve swelling, particularly in the fluid-filled pads that cushion the bones. A doctor will advise about these.
Some bunions may need to be treated with surgery. When bunions require surgery, doctors can use several different types of surgery.
Surgery may be suitable for people who:
- experience pain and inflammation that do not improve with other measures
- have a deformity that is severe enough that the toe may cross over another toe
- cannot bend or straighten a toe, due to stiffness
It is rarely used to treat adolescent bunions.
Following surgery, a full recovery can take up to 6 months, and regular visits to the doctor may be necessary.
Surgery will aim to relieve pain, realign the metatarsophalangeal (MTP) joint, and correct any deformities that are causing the problem.
Repair of the tendons and ligaments
This surgery involves shortening any weak joint tissues and lengthening the toe. Repair of the tendons and ligaments is often done in combination with an osteotomy.
A corrective procedure to realign the joint. Doctors use pins, screws, or plates to fix the bone.
A procedure to remove the joint surface that has become swollen. Screws, wires, or plates are then inserted to hold the joint together while it heals. This procedure is typically used for patients with severe bunions, arthritis, or patients who have had unsuccessful bunion surgery.
Surgical removal of the bump on the toe joint. This surgery is often performed in combination with an osteotomy. Exostectomy does not usually treat the problem that caused the bunion.
A procedure to remove the damaged portion of the toe joint, providing more space between the toe bones. This procedure is reserved for:
- Older patients
- Patients who have had unsuccessful bunion surgery
- Patients with severe arthritis who cannot undergo an arthrodesis operation
This surgical procedure is not commonly recommended.
Wearing properly fitting shoes with a wide toe box can help prevent bunions from developing. Pointy-toed and high-heeled should be avoided.
People should also avoid wearing shoes that cause cramping, squeezing, pressing, or irritation of the toes and feet.
Anyone wishing to find out about their personal bunion treatment options should speak with their healthcare provider.
This depends on the individual. Some people have problems that continue to worsen over time, while others with the underlying deformity have no symptoms. If often affects both feet in the end.