What is it?
In a bunion (hallux valgus), the first metatarsal bone drifts toward the other foot while the big toe angles toward the smaller toes. The joint at the base of the big toe becomes prominent, and the deformity is often three-dimensional, with rotation of the metatarsal as well.
What causes it?
- Inherited foot structure — bunions often run in families
- Flat feet or a hypermobile first metatarsal
- Narrow, pointed, or high-heeled shoes, which aggravate the deformity
- Inflammatory arthritis
What does it feel like?
- A painful, sometimes red bump at the base of the big toe
- Pain in shoes, especially narrow ones
- The big toe crowding or overlapping the second toe
- Pain under the ball of the foot as weight shifts
- Stiffness in the big toe joint
How is it diagnosed?
An exam of alignment and joint motion, with standing X-rays taken in the office to measure the angles and check the joint for arthritis. These measurements guide which treatment — or which procedure — is appropriate.
When should you see a podiatrist?
- Bunion pain that limits walking or shoe choice
- A second toe that is starting to bend or cross over
- Pain in the joint itself rather than just the bump
- A bunion with diabetes or poor circulation
Nonsurgical treatment
- Wider shoes
- A roomy toe box removes pressure from the bump.
- Padding and spacers
- Protect the prominence and reduce rubbing.
- Orthotics
- Improve foot mechanics and can reduce forefoot pain.
- Activity and footwear planning
- Reserving narrow shoes for short periods.
- Anti-inflammatory measures
- Ice and short courses of medication for flares.
When is surgery considered?
Surgery is considered when pain persists despite shoe changes, when the deformity is progressing, or when it is causing problems in the neighboring toes. Surgery is not recommended for cosmetic reasons alone.
The right procedure depends on the severity of the deformity, the stability of the first metatarsal, and the health of the joint. Options range from minimally invasive osteotomies to Lapidus fusion or, in an arthritic joint, fusion of the big toe joint.
Related procedures
What is recovery like?
Most bunion procedures allow protected walking in a surgical shoe or boot soon after surgery. Swelling improves over months, with a gradual return to regular shoes typically around six to eight weeks and athletic activity later.
Frequently asked questions
Do bunions get worse over time?
Many do, gradually. The rate varies a great deal from person to person, and not every bunion becomes painful.
Can a bunion be corrected without surgery?
No non-surgical treatment reverses the bone alignment, but many people stay comfortable with shoe changes, padding, and orthotics.
What is minimally invasive bunion surgery?
Correction of the bones through very small incisions using specialized instruments and imaging. It is appropriate for many, but not all, bunions.
Will my bunion come back after surgery?
Recurrence is possible, and the risk depends on the procedure chosen and the underlying foot structure. Choosing the right procedure for the deformity lowers that risk.