An Overview of Bunions

A bunion—also known as hallux valgus—is a bony protrusion that typically juts out from the side of the big toe. Less commonly, a bunion may form next to the small toe, and this is referred to as a "bunionette" or "tailor's bunion." Several factors—some of which can be controlled, some of which can't—make a person more vulnerable to developing bunions.

A doctor can usually diagnose a bunion simply by looking at your foot. Most of the time bunions are treated conservatively with self-care strategies, but surgery may be indicated in some cases.

If bunion symptoms do occur, they usually develop over time, well after the bump has formed. Symptoms may include one or more of the following:

• Soreness and/or a burning sensation over the bunion
• Redness, stiffness, and swelling around the big toe joint
• Hammertoes or calluses under the ball of the foot
• Corns or other skin irritations where the first and second toes overlap

While the precise cause behind bunion formation has not been completely sorted out, experts believe that certain foot types make a person more prone to developing bunions, and these foot types tend to run in families.

More specifically, experts suspect that a combination of a certain foot type, along with years of abnormal pressure over the big toe joint (called the first metatarsophalangeal joint), is what commonly leads to bunion formation. In particular, wearing shoes that crowd the toes together is a common culprit. This is, in part, why women tend to develop bunions more than men; many women's shoes have narrow toe boxes. High heels can make matters worse by forcing the toes even deeper into the narrowed tip.

Besides narrow footwear and an inherited foot type, other factors that may contribute to bunion formation include:

• Flat feet or low arches
• Foot injury or trauma
• Inflammatory arthritis of the foot, like rheumatoid arthritis
• Neuromuscular conditions, like cerebral palsy
• Genetic disorders, such as Ehlers-Danlos syndrome or Down syndrome

The diagnosis of a bunion can be made by physical exam alone, as this bony deformity is visible to the naked eye. That said, to fully access the bunion and big toe joint, your doctor may order an X-ray.

Treatment of a bunion is only required if it is causing symptoms. While there are numerous non-surgical treatment options available, if bunion symptoms are severe or persistent, then surgery to correct the misalignment may be considered.

Self-Care Strategies

When dealing with acute bunion pain, these self-care strategies may give you some relief:

• Remove your shoes and elevate your feet to relieve some of the pressure and inflammation.
• Apply an ice pack if the pain and swelling are extreme (aim for several 10- to 15-minute sessions a day). Be sure to move the ice pack around and place a thin towel between the pack and your skin.
• Soak your feet in cool (not ice) water to reduce swelling. Use a warm foot bath or a moist, steamed towel if you're experiencing big toe joint stiffness.
• Stretch your feet with a simple set of routine exercises to keep the foot flexible and avoid stiffness.

Medications

To ease the pain of a bunion, your doctor may recommend taking an over-the-counter anti-inflammatory medication, like Advil (ibuprofen).

Less commonly, your doctor may inject a steroid (cortisone) into the bursa (the sac surrounding the big toe joint) to relieve inflammation.

Shoe Inserts

If you have a painful bunion, you can relieve some of the pain by either padding the bunion from the outside or forcing the toes into a more natural position.

Bunion pads are readily available at most drugstores and are made either of moleskin, neoprene, foam, silicone, or a gel-filled plastic. They lessen the pressure placed on the bunion while wearing shoes and tend to work best when wearing shoes with a wide toe box. While most bunion pads are applied with a removable adhesive strip, others are woven into the fabric of removal booties.

Toe spacers, as per their name, are placed between your toes. Most are made of contoured foam or plastic. While some only open the space between the big toes, newer, glove-like models are constructed of neoprene and separate all five toes.

Among the variety of bunion relief appliances, there are night splints that can gradually correct the toe alignment and even slip-on inserts that combine a bunion pad with individual toe separators.

Proper Footwear

Even if the shoes you wear have low heels and a square foot box, they may not fit properly. Many foot problems arise simply because of choosing fashion over comfort and support.

While you may think you know your correct size, manufacturer sizes can vary enormously, leaving you swimming in some shoes and barely able to put on others. Moreover, your shoe size can change as you age since the vertical pressure placed on your feet can, over time, cause the bones and cartilage to flatten and spread.

A specialty running shoe store is a great place to get your feet measured, as these retailers are likely to conduct a comprehensive foot evaluation. This not only involves the sizing your foot but an assessment of your foot alignment and arch.

The evaluation can give you insight about what type of shoe is best for you, including whether you need custom orthotics or arch supports. The better your shoes fit, the less likely your toes will slip forward and become compressed.

If searching for the right shoe to treat bunion pain, always look for the following features:

• A toe box large enough to wiggle and spread your toes
• A heel no higher than one to two inches
• Malleable shoe material, such as canvas or a soft leather
• Enough interior space to insert bunion pads or insoles
• A moderately flexible sole (as opposed to a hard or flimsy sole)

Physical Therapy

Some podiatrists refer their patients to a physical therapist who specializes in treating foot conditions. To ease inflammation and bunion pain, your physical therapist may use ultrasound therapy.

Surgery

If your bunion pain is severe or persistent and/or diminishing your overall daily functioning/quality of life, it's sensible to discuss surgery with your doctor. The goals of bunion-reducing surgery are to alleviate bunion pain and deformity.

Depending on various factors like your age, activity level, and the severity of your bunion, your surgeon will choose one of many surgical procedures, including osteotomy (bone realignment), arthrodesis (joint fusion), resectional arthroplasty (removal of the damaged joint), or exostectomy (removal of the bunion bump only). Exostectomy is rarely performed alone; since it does not realign the big toe joint, the bunion often recurs.

If you are uncertain as to whether surgery is right for you, consider asking your foot and ankle surgeon these questions:

• What are the risks and benefits of the treatment?
• What results can I expect?
• What is involved in recovery?
• How is post-operative pain managed?

These responses, along with the cost of the recommended procedure, can help you make an informed choice.

A Word from Verywell

A bunion, albeit common, can be a frustrating foot condition to deal with. However, with the right self-care strategies and some diligence on your part, most people can manage their bunion(s) well.

That said, if you are not obtaining relief with simple measures or your bunions are affecting your mobility or daily quality of life, be sure to talk with your doctor about next steps. Surgery may be a sensible option for you at this point.