Bunions

What a bunion is

In a bunion, the first metatarsal bone angles away from the foot while the big toe angles toward the second toe. The joint between them becomes prominent on the inner edge of the foot, where the shoe rubs. Over time the joint can become stiff and painful, the big toe can push under or over the second toe, and calluses can form under the ball of the foot.^[1,2]

A smaller version on the outer edge of the foot, at the base of the little toe, is a tailor’s bunion (bunionette).

Why bunions form

Bunions run in families, and foot shape and joint laxity are major factors. They are more common in women. Footwear matters too: a systematic review found high-heeled shoes associated with hallux valgus, and ill-fitting shoes crowd the toes and make the bump hurt.^[2,3,7]

How we evaluate it

We examine the joint’s motion and position, look at the other toes and the ball of the foot, and take standing X-rays at the practice to measure the angles between the bones and check for arthritis in the joint. That tells us both what is causing your pain and which treatments make sense.^[2]

Treatment at the practice

• Shoes with a wide, deep toe box and a low heel, which take pressure off the bump.^[1,4]
• Pads and spacers that cushion the bump or separate the toes.
• Orthotics to rebalance pressure under the ball of the foot. See custom orthotics.
• Treating the painful joint: icing, anti-inflammatory medicine, and occasionally an injection for an inflamed joint.^[1]
• Monitoring: measuring the angles over time helps decide whether and when surgery makes sense.

These measures often relieve pain, but they don’t change the alignment of the bones.^[1] Our article bunions: what helps and what doesn’t goes through the options.

Common questions

Do bunion correctors and splints straighten the toe?

No. They may ease pain for some people, but no non-surgical treatment straightens the toe.^[1] A systematic review likewise found no convincing evidence that orthotics slow the progression of the deformity, although they may relieve symptoms.^[8]

Will my bunion keep getting worse?

Bunions tend to progress over time, though how quickly varies a great deal from person to person, and no treatment is known to slow or stop that progression.^[2] We measure the angles on X-ray over time, so decisions are based on how your foot is changing and how much it limits you, not on appearance.

Can a bunion come back after surgery?

Some drift of the toe is common in the long term, but a large return is not. In studies following one common bunion operation for at least five years, 64% of feet had a big-toe angle above the normal range (over 15 degrees), but only 10% were over 20 degrees and 5% over 25 degrees.^[9] The right procedure for your foot, and following the recovery plan, both matter.

Can I prevent a bunion?

You can’t change the foot shape you inherited, but you can choose shoes that don’t crowd the toes and limit time in high heels, which are associated with bunions and make them hurt.^[3,7]

When surgery is considered

Surgery is considered when pain limits walking, work or exercise despite shoe changes and other care, not for appearance alone.^[5] The procedure depends on the size of the deformity, the joint’s condition and the rest of the foot, and ranges from cutting and realigning the bone (an osteotomy), sometimes through small incisions, to fusing an unstable joint. A Cochrane review found that most comparisons between procedures rest on low-certainty evidence, which is why the choice is tailored to each foot.^[6]

When to seek care