Bunions (Hallux Valgus)

  • Medical Author:
    Philip A. Radovic, DPM, FACFAS

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Bunions facts

  • A bunion is a bony prominence from realignment of the joint 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.
  • Bunions are a progressive deformity.
  • Treatment of bunions can include rest, icing, alteration of footwear, foot supports (orthotics), medications, steroid injections, and/or surgery.

What are bunions?

The common bunion is a localized area of enlargement or prominence 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 and rotate (medically termed hallux abducto valgus deformity) toward the smaller toes. This deformity is progressive and will increase with time although the symptoms may or may not. 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, such as overpronation that can predispose to the development of bunions. This is especially common when bunions occur in younger individuals. 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. The longer limb will tend to cause the foot to overpronate.

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Read about exercises that could treat and prevent bunions.

Bunion Treatment & Exercises

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

Who develops bunions?

Bunions most commonly affect women. Some studies report that bunion symptoms occur nearly 10 times more frequently in women. It has been suggested that tight-fitting shoes, especially high-heel and narrow-toed shoes, might increase the risk for bunion formation. Tight footwear certainly is a factor in precipitating the pain and swelling of bunions. Complaints of bunions are reported to be more prevalent in people who wear closed shoes than in barefoot people.

Picture of a bunion.
Picture of a bunion. SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Other risk factors for the development of bunions include abnormal formation of the bones of the foot at birth (congenital) and arthritic diseases such as rheumatoid arthritis. In some cases, repetitive stresses to the foot can lead to bunion formation. Bunions are common in ballet dancers.

What are symptoms and signs of a bunion?

Bunions may or may not cause symptoms. A frequent symptom is foot pain in the involved area when walking or wearing shoes; rest and/or change to a wider shoe relieves this pain. Shoe pressure in this area can cause interment pain while the development of arthritis in more severe bunions can lead to chronic pain. Besides ill-fitting shoes, unsupportive flimsy soled shoes can add stress to the bunion joint and increase pain and instability to the area.

Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness. It is important to note that, in postpubertal men and postmenopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.

How do health-care professionals diagnose a bunion?

A physician will consider a bunion as a possible diagnosis when noting the symptoms described above. The anatomy of the foot, including joint and foot function, is assessed during the examination. Radiographs (X-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes when taken in a standing position (weight-bearing).

What is the treatment for bunions? Are there home remedies to treat bunions?

Nonsurgical treatments such as rest and wearing loose (wider) shoes or sandals (preferably with a supportive sole) can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that pressure the sides of the foot.

Anti-inflammatory medications, such as acetylsalicylic acid (aspirin, Ecotrin), ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation, as well as pain. Local cold-pack application is sometimes helpful, as well.

Bunion shields or pads can reduce pressure on the bunion. Depending on the structure of the foot and severity of the bunion, custom insole orthotics can slow the progression of the bunion and address underlying biomechanical causes such as overpronation.

Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone.

Constant pressure or friction can lead to skin breakdown and infection that may require antibiotic therapy.

When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care.

For those whose bunions cause persisting pain, a surgical operation is considered for correction of the bunion. The surgical operation to correct a bunion is referred to as a bunionectomy. Surgical procedures can correct deformity and relieve pain, leading to improved foot function. These procedures typically involve removing bony growth of the bunion while realigning the big toe joint. Surgery is often, but not always, successful; failure to relieve pain can result from the big toe moving back to its previous deviated position even after surgery. However, proper footwear and orthotics can reduce the chances of surgical failure.

Quick GuideBurning or Swollen Feet? What Foot Pain Says About Your Health

Burning or Swollen Feet? What Foot Pain Says About Your Health

Is it possible to prevent bunions?

If the diagnosis is made early on, such as in preadolescence, bunion development can be slowed and, in some cases, arrested with the proper supportive shoe gear and custom functional shoe inserts (orthotics). Avoidance of certain athletic activities with improper shoe fit and toe pressure can prevent the symptoms that occur with bunions. Early examination by a podiatrist is recommended.

What is the prognosis of a bunion?

The treatments described above are very effective in treating bunion deformities, and the prognosis can be excellent. However, the correct diagnosis is essential to define any underlying associated deformities as well as the bunion severity. Also, a bunion is a progressive deformity and will get worse with time. It can cause instability to the rest of the foot and sometimes lead to arthritis in the joint at the base of the big toe. It is, therefore, advised to consult with a foot specialist to fully evaluate a bunion.

REFERENCE:

Klippel, John H., eds., et al. Primer on the Rheumatic Diseases, 13th ed. New York: Springer, 2008.

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Reviewed on 2/24/2016
References
REFERENCE:

Klippel, John H., eds., et al. Primer on the Rheumatic Diseases, 13th ed. New York: Springer, 2008.

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