Bunions

About bunions

A bunion is a bony lump on the side of your foot, which develops when your big toe starts to angle towards your second toe. The bunion will eventually cause you discomfort and pain. The skin over the lump can become red, blistered or infected. A fluid-filled space called a bursa may also develop under your skin in this area and this can be painful if it becomes inflamed. This is called bursitis. The deformity of your big toe combined with a bunion is sometimes referred to as hallux valgus by your GP.

Symptoms of bunions

If you have a bunion, you may have:

  • pain or stiffness of your big toe joint
  • swelling of your big toe joint
  • difficulty walking
  • difficulty finding shoes that fit

These symptoms may be caused by conditions other than bunions, but if you have any of these symptoms, see your GP.

Causes of bunions

You can get a bunion because of a problem with your big toe known as hallux valgus. ‘Hallux’ means the big toe and ‘valgus’ means that it’s pointing outwards towards your other toes. 

In hallux valgus, the bone in your foot at the base of your big toe, called the first metatarsal, moves out at the side of your foot. Your big toe then angles towards your other toes.

There are many factors that can contribute to bunions forming. Some of these include the following.

  • The most common cause of bunions is a problem with the way you walk. This is often caused by your foot rolling inwards as you walk. Over time, this problem can lead to a bunion forming.
  • Bunions can run in families, but just because your parents or grandparents have bunions, you won’t necessarily develop them too.
  • You’re much more likely to get bunions if you’re a woman. This may be because the ligaments in the foot (the structures that connect bones together) are usually looser in women than in men.
  • The type of shoes you wear may also affect whether or not you get a bunion. If you wear narrow or high-heeled shoes, this can put extra strain on the bones and muscles in your foot. This, in turn, can push your toes together (‘crowding’ the toes) and forces your big toe to point towards your other toes. Wearing poorly fitting shoes doesn’t cause bunions on its own, but it can worsen them.
  • Bunions are also sometimes associated with joint conditions such as osteoarthritis.
  • Other causes of bunions include gout, rheumatoid arthritis or an injury to your foot.

Diagnosis of bunions

Your GP will be able to diagnose a bunion by asking about your symptoms and examining your feet. You may also have blood tests to rule out any other medical conditions, such as rheumatoid arthritis or gout, although this is rare. Your GP may refer you to a podiatrist or chiropodist (healthcare professionals who specialise in conditions that affect the feet).

Treatment of bunions

Wearing the right shoes, using shoe inserts (orthoses) and padding, and taking painkillers can all help to ease your symptoms of a bunion. However, these treatments can’t cure a bunion or stop it getting worse. If you have severe pain or discomfort from a bunion, you may be advised to have an operation to correct it.

Self-help

One of the most important things you can do is to wear the right footwear. You should try to wear flat, wide-fitting shoes with laces or an adjustable strap that fits you properly. You may also want to place a bunion pad over your bunion to give it some protection from the pressure of your shoes. You can usually buy these pads from a pharmacy, or get them from your podiatrist or chiropodist. He or she may also recommend a shoe insert, which can be moulded specifically to your foot. Shoe inserts aim to reduce the pain of your bunion by improving how you walk.

Medicines

You can take over-the-counter painkillers, such as paracetamol or ibuprofen, to help relieve the pain and inflammation of your bunion. Always follow the instructions in the patient information leaflet that comes with your medicine. Medicines give temporary relief but they won’t be able to cure your bunion or prevent it from getting worse.

If you have a bunion as a result of underlying arthritis, your GP may prescribe specific medicines to treat this.

Surgery

If other treatments don’t help and your bunion is very painful, you may be referred to an orthopaedic or a podiatric surgeon for assessment. There are over 130 different operations that can be carried out to treat bunions. The simplest operations are called bunionectomies.

The majority of the operations aim to correct the alignment of your big toe. This will narrow your foot and straighten out your big toe joint as much as possible. An operation won’t return your foot back to normal, but most people find that surgery reduces their symptoms and improves the shape of their foot. The operation your surgeon will advise you to have will depend on how severe your bunion is and whether or not you have arthritis.

For more information on bunion surgery, see Related topics.

Prevention of bunions

You can reduce your risk of getting a bunion by wearing the right type of footwear. In particular, wearing tight, high-heeled shoes may make bunions worse. You can ask your GP or podiatrist for advice about your footwear. He or she will probably advise:

  • that your shoes are wide enough so there isn’t any pressure on the joints at the sides of your feet
  • choosing shoes with a low heel and a wide toe box where you can wiggle your toes comfortably
  • shoes with adjustable fastenings, such as laces, buckles or straps, that hold your feet comfortably inside your shoe
  • using soft insoles in your shoes as shock absorbers

If I have a bunion, does it mean I'll get osteoarthritis in my big toe?

Answer

No, not everyone with a bunion develops osteoarthritis. However, the movement of your big toe inwards may mean that you’re more at risk of developing the condition.

Explanation

If you have a bunion, it doesn't mean that you will definitely get osteoarthritis in your big toe, although this can happen in some people. It’s more common the other way around, in that if you have osteoarthritis in your toe, you’re more likely to get a bunion. Your toe joint is more prone to osteoarthritis than any other joint in your foot because of the repeated pressure you put on it when you walk.

Osteoarthritis is a condition that affects your joints making them stiff and painful. It causes the cartilage on the end of your bones to get rougher and thinner. The bone beneath compensates by thickening and growing outwards, creating outgrowths (osteophytes). These make your joint look misshapen and knobbly. The capsule around the joint also thickens and becomes inflamed.

The joints most affected by osteoarthritis are your knees, hips, hands and big toes. There are many factors that can increase your risk of developing osteoarthritis, such as:

  • being aged 40 or older
  • being overweight
  • having parents who have osteoarthritis
  • injuring your joint

If you have any concerns about bunions or osteoarthritis, talk to your GP.

What is a podiatrist and how can I find one?

Answer

A podiatrist is a health professional who treats conditions affecting your feet. Your GP may be able to refer you to a podiatrist. Alternatively, you can find one by contacting professional bodies, such as the Society of Chiropodists and Podiatrists.

Explanation

A podiatrist treats problems with feet and is trained to treat people with medical conditions like arthritis and diabetes, as well as sports injuries. Podiatrists are also able to diagnose conditions and give you advice on how to take care of your feet. They are sometimes called chiropodists as well. Podiatrists aren't doctors, but they do have specialist training and often work closely with doctors.

Podiatrists can recommend exercises, devices and shoe alterations that may help relieve your symptoms. However, they aren't able to cure your condition. For this, you may be referred to a podiatric surgeon. A podiatric surgeon is a podiatrist who is specially trained to carry out surgical procedures. This includes treating bunions. Orthopaedic surgeons also provide this type of treatment.

There are several ways that you can get in touch with a podiatrist. Your GP may be able to either recommend someone in your local area or refer you to a podiatrist. Alternatively, you can contact the Society of Chiropodists and Podiatrists who represent over 10,000 practising podiatrists. It's important to find a podiatrist or chiropodist who is a member of the Health and Care Professions Council (HCPC). This will ensure that you see a registered professional.

If you have any question about podiatry or bunions, talk to your GP.

How long will it take until I can walk after bunion surgery?

Answer

It’s likely that your initial recovery from bunion surgery will take about six weeks, depending on the type of operation you have had.

Explanation

The length of time it takes for you to recover from bunion surgery will depend on the type of operation you have had. You may have to wear a plaster cast or protective shoe after some types of operation. You will probably be advised to walk as little as possible in the first four days after your operation and to sit with your foot raised to help relieve swelling and pain. You may also be advised to use crutches for the first few weeks.

It can take up to three months until you can walk normally again. However, it's important to remember that individual recovery times can vary. One person may feel no pain and recover very quickly, whereas another may be in discomfort and take a long time to heal. It depends on your individual circumstances.

When you can return to work will depend on the type of operation you have had and how much time you spend on your feet doing your job. Your surgeon will give you advice about returning to work.

If you have any questions or concerns about bunions or surgery to correct them, talk to your GP or surgeon.