Bunions (Hallux Valgus)

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Bunions facts

  • Bunions involve boney prominences and repositioning of the joints at the base of the big toes.
  • Bunions most commonly affect the inner foot at the base of the big toe but also can affect the outside of the foot at the base of the little toe, referred to as a bunionette or tailor's bunion.
  • Bunions most commonly affect women.
  • Bunions may or may not cause symptoms.
  • Treatment of bunions can include rest, icing, alteration offootwear, foot supports (orthotics), medications, steroid injections, and/or surgery.

What are bunions?

The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents a misalignment of the big toe joint (metatarsal phalangeal joint) and, in some cases, additional bone formation. The misalignment causes the big toe to point outward (medically termed hallux valgus deformity) toward the smaller toes. This deformity is progressive and will increase with time. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A more deep joint pain may occur as localized arthritis develops in later stages of the deformity.

A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion or bunionette.

What are the causes of bunions?

While the precise cause is not known, there seem to be inherited (genetic) factors that lead to abnormal foot function like overpronation that can predispose to the development of bunions. This is especially common when bunions occur in younger individuals. This abnormal biomechanics can lead to instability of the metatarsal phalangeal joint and muscle imbalance resulting in the deformity.

Although shoe gear doesn't directly cause a bunion, it can certainly make the bunion painful and swollen. Other less common causes of bunion deformities include trauma (sprains, fractures, and nerve injuries), neuromuscular disorders (polio or Charcot-Marie-Tooth disease) and limb-length discrepancies (one leg shorter than the other) where the longer leg develops the bunion.

Medically Reviewed by a Doctor on 6/27/2014

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Read about exercises that could prevent bunions.

All of the women in my family have horrible bunions. Are there any exercises that can ward off or help bunions?

Author: Richard Weil, MEd, CDE
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

A bunion is an irregular bony prominence (a bump) on the joint where your big toe meets the main bones of your foot. The bunion causes the end of the big toe to bend toward the other toes and crowd them, while the bone at the base of the toe where it meets the foot moves outward beyond the normal limits of where the bone should be. Pain is caused by inflammation and the bone pressing against the shoe. Bunions are more common in women, as you report, and are caused by a number of reasons, including shoes that are too tight, years of abnormal motion (like dancers on point), poor foot mechanics, bone deformities, flat feet, and arthritis.

Treatment usually includes shoes with a roomy toe box (you should be able to wiggle your toes; the toe box should be wide enough to accommodate the bony prominence), padding, over-the-counterarch supports, orthotics, and taping by a physical therapist or doctor. Surgery is an option when conservative treatment fails and you have chronic pain.

Picture of a bunion