A bunion is a deformity of the base joint of the big toe. The cause is not clear in many cases. The deformity may cause the foot to rub on shoes which may cause inflammation and pain. Good footwear is often all that is needed to ease symptoms. An operation to correct the deformity is an option if good footwear does not ease symptoms.
A bunion is when your big toe is angled towards the second toe. This causes a bump on the side at the base of the big toe. In addition there is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful.
Sometimes a fluid-filled sac (bursa) develops over the joint.
The underlying cause is a deformity of the joint at the base of the big toe. The deformity is called hallux valgus. In this deformity the joint develops a prominent sideways angle. Due to this deformity the bones of the big toe are pushed towards the smaller toes.
The skin over the angled joint then tends to rub on the inside of shoes. This may cause thickening and inflammation of the overlying skin and tissues next to the affected joint.
In most cases it is not clear why a hallux valgus deformity develops. There may be some genetic (hereditary) tendency to have a weakness of this joint. In some cases it is associated with a joint problem such as osteoarthritis or rheumatoid arthritis.
However, whatever the underlying cause, wearing tight or badly fitting shoes tends to make the problem worse. Wearing such shoes puts extra pressure on the big toe joint and causes friction on the overlying skin.
Wearing good footwear does not cure the deformity but may ease symptoms of pain and discomfort. Ideally, get advice about footwear from a podiatrist or chiropodist.
Advice may include:
Painkillers such as paracetamol or ibuprofen may ease any pain. If the bunion develops as part of an arthritis then other medication may be advised. A course of antibiotics may be needed if the skin and tissues over the deformity become infected.
An operation may be advised if a change of footwear does not ease symptoms. The aim of the operation is to straighten the joint as much as possible and relieve pain. It is not usually done just to improve appearance. It can be done using a local or a general anaesthetic and you are usually out of hospital the same day.
There are many different types of operation which are used to treat bunions. These range from operations to trim parts of the joint, to a total artificial replacement of the big toe joint (similar to a knee or a hip replacement). The operation chosen by the specialist depends on the severity of the bunion, the shape of your foot, and other factors, such as if you have arthritis in the joint.
An operation is usually successful at easing symptoms, but not in all cases. It is not always possible to relieve the pain completely or make the toe perfectly straight. Your specialist will be able to advise on the pros and cons of surgery, and the success rate of the chosen operation. Continued pain, infection and recurrence of the bunion are some of the complications of surgery of which you need to be aware.
You will need to continue to wear sensible, wide-fitting shoes for six months after the operation.