A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. The big toe may turn toward the second toe. The tissues around the joint may be swollen and tender.
A bony bump at the base of the little toe is called a bunionette or tailor's bunion. The little toe also bends inward, and the joint swells or enlarges.
What causes a bunion?
You may get bunions if:
The way your foot is shaped puts too much pressure on your big toe joint. Because bunions can run in families, some experts believe that the inherited shape of the foot makes some people more likely to get them.
Your foot rolls inward too much when you walk. A moderate amount of inward roll, or pronation, is normal. But damage and injury can happen with too much pronation.
You have flat feet.
You often wear shoes that are too tight.
All of these may put pressure on the big toe joint. Over time, the constant pressure forces the big toe out of alignment, bending it toward the other toes.
What are the symptoms?
Your bunion may not cause any symptoms. Or you may have pain in your big toe, red or irritated skin over the bunion, and swelling at the base of the big toe. The big toe may point toward the other toes and cause problems in other toes, such as hammer toe. A bunionette can cause similar symptoms at the base of the little toe.
How are bunions diagnosed?
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight.
X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout, rheumatoid arthritis, or joint infection.
How are they treated?
Currently, no strong evidence points to the best treatment for bunions. But in most cases, you can treat them at home. This includes taking medicine you can buy without a prescription to relieve toe pain. It also helps to wear shoes that do not hurt your feet. For example, avoid high heels or narrow shoes. You can wear pads to cushion the bunion, and in some cases, you can use custom-made shoe inserts (orthotics).
Avoid activities that put pressure on your big toe and foot. But don't give up exercise because of toe pain. Try activities that don't put a lot of pressure on your foot, such as swimming or bicycling.
Surgery to correct a bunion may be an option if other treatment does not relieve pain. There are different types of surgery for bunions. You and your doctor can decide which one is best for you.
How can you prevent bunions?
Proper footwear may prevent bunions. Wear roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint.
Medicine will not prevent or cure bunions.
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Bunions may be caused by foot mechanics that result in too much pressure on the joint at the base of the big toe (metatarsophalangeal joint). An abnormal foot motion called excessive pronation, having certain foot shapes such as flatfoot, and wearing shoes that squeeze the toes together or shift weight to the toes (such as high-heeled shoes) may all contribute to the pressure. Over time, the constant pressure forces the big toe out of alignment, gradually bending it toward the other toes (displacement).
A bunionette, or tailor's bunion, is one that develops at the base of the little toe. When the long bone that connects to the toe (metatarsal) bends away from the foot, the little toe bends inward and the joint swells or enlarges.
Hammer toe or removal (amputation) of the second toe. When the joint of the second toe rises, as in hammer toe, or the second toe is missing, it becomes easier for the big toe to drift toward the other toes.
Displacement of the big toe toward the other toes.
Joint redness.
Joint pain or stiffness.
Skin irritation over the bunion.
A bunionette causes symptoms that occur at the base of the little toe.
Bunions and their symptoms develop gradually. They are sometimes confused with symptoms of gout, but gout pain comes on suddenly and can be more severe than bunion pain. Gout pain and swelling tend to occur in episodes, while bunion pain is more constant. Unlike a bunion, gout does not usually cause joint deformity. For more information, see the topic Gout.
What Happens
Bunions on the big toe often begin when an abnormal foot motion called excessive pronation transfers weight to the inner edge of the sole of the foot. This and other factors, such as having flatfoot and wearing tight-fitting shoes, can result in too much pressure on the joint at the base of the big toe, causing the big toe to bend in toward the smaller toes.
A bunion can affect the other toes. As a result of the pressure of the big toe moving toward other toes, you may develop:
Ingrown nails (the toenail begins to grow into the toe).
A bunion can increase the risk of osteoarthritis in the big toe joint.
What Increases Your Risk
Bunions can develop at any time and are found in both children and adults. You are at increased risk for having bunions if you:
Are female. Women are much more likely than men to get bunions.
Wear shoes that are too tight or narrow, too small, or high-heeled. This is one reason bunions are more common in women. Men's shoes tend to fit the actual size of their feet more closely.
Have abnormal rolling inward of the foot while walking (excessive pronation).
Have a family history of bunions.
Have rheumatoid arthritis, which can cause swelling and deformity around the big toe joint (and other joints).
Have gout, a form of arthritis that often occurs in the big toe joint.
Have a job or hobby (such as running) that places considerable stress on the foot.
You have severe pain in your big toe that interferes with walking or daily activities.
Your big toe starts to overlap or cross under your second toe (displacement).
You have diabetes or peripheral arterial disease and the skin over a bunion is irritated, red, or broken. Diabetes and peripheral arterial disease can reduce blood circulation and sensation in your feet. Infection can develop more quickly and may lead to other serious problems.
Pain in your big toe does not get better after 2 to 3 weeks of home treatment.
Watchful waiting
Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting may be appropriate if bunion pain is not severe. In this case, try home treatment, such as using ice to relieve pain or wearing comfortable footwear. If there is no improvement after 2 to 3 weeks of home treatment, call your doctor.
Who to see
Symptoms of a bunion can be evaluated and treated by:
Podiatrists, who also provide surgical bunion treatment.
Orthopedists, who primarily provide surgical treatment.
Exams and Tests
If you have a bunion, you will notice a bump on your big toe joint. The big toe may turn toward the second toe (displacement), and the tissues surrounding the joint may be swollen and tender.
Bunions are diagnosed through a medical history and physical exam. This may include:
Asking about your history of symptoms, including when they started, what activities or shoes make them worse, and whether other joints are painful.
Examining your toe and joint and evaluating their range of motion. This is done while you are sitting and while you are standing, so that the toe and joint can be observed both at rest and while bearing weight.
Checking your reflexes, pulse, and sensation, to rule out other problems.
Tests that may be done
X-rays are often used to find out the degree of bone deformity or to rule out other causes of pain and swelling. If surgery is being considered, X-rays can help your doctor determine what type of surgery will be most helpful in treating the symptoms. X-rays usually are done while you are standing so that the foot is bearing weight. In some cases, magnetic resonance imaging (MRI), computed tomography (CT scan), or a bone scan is also used.
Further tests, such as blood tests or arthrocentesis(removal of fluid from a joint for analysis), are sometimes done if other conditions that can cause joint pain and swelling are suspected, such as gout, rheumatoid arthritis, or joint infection.
Treatment Overview
If you have a bunion but do not have pain or discomfort, treatment may not be necessary. The goals of treatment for bunions are both to relieve toe pain so that it does not limit daily activities and to prevent the bunion from getting worse.
Most bunions can be treated at home. In some cases, surgery is considered.
Nonsurgical treatment
Nonsurgical treatment usually is used to decrease pressure on the big toe and relieve pain. Treatment includes:
Wearing roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint.
Using bunion pads, arch supports, or custom-made supports (orthotics). They can help redistribute your weight while you are walking and take pressure off your big toe. Ask your doctor to help you choose the right kind of pads.
Using moleskin or felt patches over or around pressure areas, to protect the bunion from being rubbed by your shoes.
Taking nonprescription medicine to relieve pain and reduce swelling. Examples include acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. Talk to your doctor about which pain reliever is best for you.
Using ice to relieve pain and reduce swelling. Apply ice to the joint for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. Elevate your foot so that your toe is higher than your heart.
Physical therapy, splints, or braces have not been proved to successfully treat bunions. But these treatments may be helpful for some people.
Surgical treatment
If nonsurgical treatment has not relieved toe pain and you aren't able to do normal daily activities, or if you have a severe bunion, you may want to consider surgical treatment. Bunion surgery is done to help restore normal alignment to the toe joint and relieve pain.
There are different types of bunion surgery-the best type of surgery for you depends on how severe your bunion is and how experienced your surgeon is. Look for a surgeon who does many different types of bunion surgery on a regular basis. Each bunion is different, and surgery needs to be tailored to each case.
Prevention
Proper footwear can help reduce the risk of bunions.
Wear roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint.
Preventing too much rolling inward of the foot (excessive pronation) during walking or running may help prevent bunions. Excessive foot pronation has been linked to bunion formation. You may be able to prevent excessive pronation by wearing supportive shoes or using arch supports. If you still have excessive pronation, your doctor may suggest that you have custom orthotic shoe inserts made for you.
Home Treatment
Home treatment can help relieve toe pain and may prevent a bunion from getting worse. Home treatment includes:
Avoiding activities that put pressure on your big toe and foot. Don't give up exercise because of toe pain. Try activities that don't put a lot of pressure on your foot, such as swimming or bicycling.
Wearing roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint.
Use nonprescription medicine such as acetaminophen (Tylenol, for example) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. Talk to your doctor about which pain reliever is best for you.
Apply ice to the joint for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. Elevate your foot so that your toe is higher than your heart.
Try bunion pads, arch supports, or custom-made supports (orthotics) placed just behind the big toe joint on the bottom of your foot. This redistributes your weight while you are walking and takes pressure off your big toe. Ask your doctor to help you choose the right kind of pads.
Put moleskin or felt patches over or around pressure areas, to protect the bunion from being rubbed by your shoes.
Stretch the parts of your shoes that rub on painful areas. Look for a shoe repair shop or cobbler that stretches shoes, or ask your doctor to recommend one. You may also want to find a shoe manufacturer that makes special or custom shoes for people with foot problems.
For children with bunions, using orthotic insoles to correct a walk where the foot rolls inward (excessive pronation) is questionable. Some studies show that bunions in children may not be related to pronation.footnote 1
Children who have bunions should see a doctor if foot pain is limiting their activity. In some cases, the doctor may recommend surgery.
Medications
Medicine will not prevent or cure bunions. But it may relieve pain and inflammation and allow you to do your normal daily activities. Be safe with medicines. Read and follow all instructions on the label.
If your toe pain is not severe, you can try nonprescription medicine first, such as:
Bunion surgery generally involves making an incision in the top or side of the big toe joint area and removing or realigning soft tissue and bone. The goals of surgery for bunions are to:
Relieve pain and restore normal alignment to the toe joint.
Restore, as much as possible, normal weight-bearing distribution to the foot.
Allow you to return to normal activities.
You may have to consider surgery if your bunion results in persistent, severe pain that limits your daily activities or if you have a severe foot deformity.
Have other health problems that make surgery dangerous. If you have diabetes, neuromuscular disorders, or circulatory problems that limit blood flow to your feet, discuss the risks of surgery with your doctor. Such conditions increase the chance of complications after surgery.
Have unrealistic expectations about the results of surgery (such as being able to wear any kind of shoe).
Joint replacement surgery is not often done to repair a bunion. If your doctor recommends joint replacement, get a second opinion.
Some issues to consider when deciding about bunion surgery:
The type of surgery used depends not only on how severe the bunion is but also on your surgeon's experience. Look for a surgeon who does many different types of bunion surgery on a regular basis. Each bunion is different, and surgery needs to be tailored to each case. Research does not show which type of surgery is best.
Bunions may return after surgery, especially if you continue to wear narrow or high-heeled shoes.
Your expectations may influence your satisfaction with the surgery. For example, although surgery may improve your foot's appearance, those who make appearance their primary reason for surgery are generally disappointed in the results. Discuss your expectations with your doctor.
Surgery may reduce the flexibility of the big toe joint, which may be a concern if you are active and need a full range of motion in the big toe.
You will have to stay off your foot for a while after surgery.
Other Treatment
Treatment options for bunions include arch supports, custom-made orthotics, and custom-made shoes. All of these temporarily change the way the bones, muscles, and ligaments of the foot work together. They will not cure the bunion, but they may help relieve some structural problems that are contributing to it by:
Reducing pressure on the big toe joint.
Preventing too much rolling inward of the foot (excessive pronation) during walking or running. Excessive foot pronation has been linked to bunion formation.
Helping keep the toe joint in a more normal alignment and controlling the shortening of ligaments and other tissues that may be pulling the joint out of alignment.
Arch supports are available without a prescription. Orthotics and custom-made shoes are available with a prescription and are professionally fitted to your foot.
Ferrari J (2014). Hallux valgus (bunions). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1112/overview.html. Accessed January 14, 2015.
Other Works Consulted
American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Hallux valgus. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 819-821. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Ferrari J (2014). Hallux valgus (bunions). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1112/overview.html. Accessed January 14, 2015.
Perera AM, et al. (2011). The pathogenesis of hallux valgus. Journal of Bone and Joint Surgery, American Version, 93(17): 1650-1661.
Vanore JV, et al. (2003). Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1. Hallux valgus. Journal of Foot and Ankle Surgery, 42:(3) 112-123.
Credits
ByHealthwise Staff Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Gavin W. G. Chalmers, DPM, FACFAS - Podiatry and Podiatric Surgery
Ferrari J (2014). Hallux valgus (bunions). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1112/overview.html. Accessed January 14, 2015.
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