A bunion (also known as hallux valgus) is a painful swelling on the inside of the big toe. It develops gradually over time. Often the big toe will look as if it is bent in towards the other toes or even can lie across them.
- Bunion pain develops gradually over time and becomes progressively worse. In the very early stages, you may have no symptoms at all. Gradually deformity occurs on the inside forefoot.
- Eventually, pain will be felt in and around the base of the big toe, particularly on the inside.
- Symptoms may sometimes be relieved by removing your shoes or wearing soft wide fitting shoes instead.
- Your big toe will appear to be bent inwards towards the other toes. In some cases it can overlap the adjacent toe.
- An X-ray may be done to determine the extent of the deformity and any wear and tear of the joint.
What is a bunion?
A bunion (Hallux Valgus), is a painful swelling on the inside of the big toe. It occurs to some extent in almost a quarter of adults aged between 18 and 651. It is more common in women and older people. However, teenagers can also develop the condition2.
Bony exostosis (small growths of bone) form around the joint at the base of the big toe. This joint is known as the first MTP joint. Eventually deformity develops. Sometimes there is also inflammation of the bursa or small sack of fluid which lubricates between tendon and bone.
In more severe cases the deformity can make it difficult to wear certain types of shoes. This is due to the pressure on the joint, or from bone rubbing against the shoe.
What causes a bunion?
- Pressure on the inside of the forefoot which causes the 1st metatarsal bone in the foot to migrate outwards.
- Poorly fitting shoes.
- Biomechanical factors can contribute to the development of Hallux Valgus for example if you overpronate where the foot rolls in or flattens excessively which causes the inside of the foot to rub against the shoe.
- Wearing high heeled shoes regularly also increases the risk of developing the condition. The pressure on the forefoot is increased considerably as the heel is raised up.
- Age is also a factor as the ligaments lose strength as you get older.
- Increased length of the first metatarsal bone in the foot3.
- Direct trauma or impact to the ligaments on the inside of the foot, or to the sesamoid bones.
- Other causes include Achilles tendon shortening, degeneration of the joint, neuromuscular disorders and collagen deficient diseases.
Initial treatment for bunions is based on reducing pain and correcting any biomechanical problems of the foot. Later or in more severe cases surgery will be required.
Orthotic shoe inserts
- If your foot rolls in (or overpronates) then this causes the arch of the foot to flatten. As a result, more pressure is placed on the base of the big toe where the bunion forms.
- A podiatrist is a therapist who specializes in feet can do a full gait analysis and make orthotic inserts to correct biomechanical foot problems.
- This can be done with conservative treatment before surgery is attempted but it is also common for patients to wear corrective following surgery for a bunion.
- Off the shelf orthotic insoles can be worn to help correct any biomechanical problems in the foot which may be causing the problem.
Severe cases may require surgery to realign the joint into a better position, but this is the last resort if conservative treatment has failed or just walking is painful.
Surgery is usually done as an outpatient procedure so the patient does not have to stay in a hospital overnight although it is usually performed under a general anesthetic.
The procedure involves the surgeon making a cut on the inside of the big toe joint and removing excess bone whilst also repositioning ligaments and tendons. The joint may be fixed with screws or wires, which may be dissolved, or may be removed at a later date or in some cases, remain in the foot permanently.
After the operation, the foot will be immobilized, often in a cast for 4 to 8 weeks to keep the bones in alignment. Crutches will usually be issued to help the patient get around. After this period, the foot will be assessed to check the bones have healed correctly. At which point full weight bearing may be gradually introduced.
Read next: Bunion taping
References & further reading
- Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res 2010;3:21.
- Shine J, Weil L, Weil LS et al. Scarf osteotomy for the correction of adolescent hallux valgus. Foot Ankle Spec 2010;3:10–4.
- Munuera PV, Polo J, Rebollo J. Length of the first metatarsal and hallux in hallux valgus in the initial stage. Internat Orth (SICOT) 2008;32:489–95.