Bunions

A bunion, medically called hallux valgus, is a slowly worsening deformity at the base of the big toe. The big toe drifts toward the smaller toes while the long bone behind it shifts the other way, leaving a bony bump on the inside of the foot. The tendency is largely inherited and is more common in women. Narrow or pointed shoes do not cause it but speed its progression in people who are prone to it. Over time the bump can make footwear painful and change the way you walk. A bunion does not correct itself without surgery, but its symptoms can be managed, and most people stay active in comfortable shoes.

Common symptoms include:

• A bony bump on the inside of the foot that can be red, swollen, and tender
• Pain at the bump, usually worst in narrow or pointed shoes
• Difficulty finding shoes that fit comfortably
• A thickened, painful callus under the ball of the foot
• A bent or crossed-over second toe as the deformity progresses

The diagnosis is made from your symptoms, an examination of how far the toe has drifted and how stable the joint is, and weight-bearing X-rays. Loading the foot reveals the true angle between the bones, which guides nonsurgical planning and, when surgery is considered, the choice of procedure. An MRI is rarely needed.

Nonsurgical care relieves pressure on the bump but does not straighten the toe:

• Wider shoes with a broad, rounded toe box, often the single most useful change
• A gel or padded sleeve to cushion the bump from shoe friction
• Toe spacers or a custom orthotic to ease discomfort and spread load
• Anti-inflammatory medication for pain and swelling during a flare

Surgery is considered when pain limits daily life despite footwear changes. The reason to operate is pain, not appearance. Most procedures cut and reposition the first metatarsal to correct the alignment, with the approach chosen from the X-rays.

• BunionectomyFoot & Ankle

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Bunions — AAOS OrthoInfo