Bunions

What is a bunion (hallux valgus)?

• The medical term for bunions is hallux (big toe) valgus (knock-kneed).
• A bunion presents as a painful bony bump, but it isn’t new bone, just normal bone that is made prominent by the toe drifting over.
• Bunions are caused by a variety of things and progress slowly.

What causes bunions?

• Years of abnormal foot pressures.
• Poor footwear is a major cause. The worst shoes are those with high heels, no laces and narrow toes. See more about our footwear recommendations below.
• Your family history – most patients with bunions have family members that also have bunions.
• Some inflammatory conditions or conditions that affect the shape of your foot (e.g. rheumatoid arthritis or diabetes).

How do you know if you have a bunion?

• You will see a noticeable bump on the base of your big toe.
• There is pain over the bump, or near the base of the second toe.
• You may have limited movement in your big toe and there may be redness or inflammation.
• Pain often gets worse when wearing tight shoes and/or increased activity.
• How is this officially diagnosed? Your physician will take a history and do an examination to confirm that you have a bunion. They will require an X-ray of your foot for this.

What is the treatment for bunions?

Treatment for bunions can be surgical or non-surgical. Most are treated non-surgically.

1. Non-Surgical
   1. Changes in footwear.
   2. Pads can be placed over the bunion to decrease the pressure and thereby decrease the pain. Be sure that the pad does not increase the pressure on the deformity. Many drug stores carry these pads.
   3. Toe spacers can be placed between the big toe and the second toe to decrease the bunion deformity, which may decrease the bunion symptoms. Bunion splints may be used at night.
   4. Orthotics (special shoe inserts) to take the pressure off the bunion can be bought over-the-counter or custom-made.
   5. Activity modification: avoid any activity that causes pain, including standing for long periods of time.
   6. Icing: applying an ice pack several times a day for 20 minutes at a time can reduce pain and inflammation. Ice should not be applied directly on your skin.
   7. Medications: oral non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil ©) may help to reduce pain and inflammation.
   8. None of the above interventions prevent the formation or progression of bunions.
2. Surgical
   1. There are a variety of surgeries that can be done to correct bunion deformities. They all involve different combinations of bone removal, realigning bones, releasing and adjusting soft tissues. Sometimes the joint is even fused. Although the joint doesn’t move anymore, the foot stays straight.
   2. Recovery from surgery can be painful and take from 6 months to 1 year for all of the swelling to go away. Depending on the type of surgery you had you may not be able to put full weight on your foot for several weeks.
   3. For more information on foot and ankle surgery, see our ‘What to Expect Post-Surgery’ page.