Bunions

Overview

A bunion is a bony bump that forms on the joint at the base of your big toe. It occurs when some of the bones in the front part of your foot move out of place. This causes the tip of your big toe to get pulled toward the smaller toes and forces the joint at the base of your big toe to stick out. The skin over the bunion might be red and sore.

Wearing tight, narrow shoes might cause bunions or make them worse. Bunions can also develop as a result of the shape of your foot, a foot deformity or a medical condition, such as arthritis.

Smaller bunions (bunionettes) can develop on the joint of your little toe.

Symptoms

The signs and symptoms of a bunion include:

• A bulging bump on the outside of the base of your big toe
• Swelling, redness or soreness around your big toe joint
• Corns or calluses — these often develop where the first and second toes rub against each other
• Ongoing pain or pain that comes and goes
• Limited movement of your big toe

When to see a doctor

Although bunions often require no medical treatment, see your doctor or a doctor who specializes in treating foot disorders (podiatrist or orthopedic foot specialist) if you have:

• Ongoing big toe or foot pain
• A visible bump on your big toe joint
• Decreased movement of your big toe or foot
• Difficulty finding shoes that fit properly because of a bunion

Causes

There are many theories about how bunions develop, but the exact cause is unknown. Factors likely include:

• Inherited foot type
• Foot stress or injuries
• Deformities present at birth

Experts disagree on whether tight, high-heeled or too-narrow shoes cause bunions or whether footwear simply contributes to the development of bunions.

Bunions might be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis.

Risk factors

These factors might increase your risk of bunions:

• High heels. Wearing high heels forces your toes into the front of your shoes, often crowding your toes.
• Ill-fitting shoes. People who wear shoes that are too tight, too narrow or too pointed are more likely to develop bunions.
• Rheumatoid arthritis. Having this inflammatory condition can make you more likely to develop bunions.
• Heredity. The tendency to develop bunions might be the result of an inherited problem with the structure or anatomy of your foot.

Complications

Possible complications of bunions include:

• Bursitis. This painful condition occurs when the small fluid-filled pads that cushion the bones near your joints become inflamed.
• Hammertoe. An abnormal bend that occurs in the middle joint of a toe, usually the toe next to your big toe, can cause pain and pressure.
• Metatarsalgia. This condition causes pain and swelling in the ball of your foot.

Prevention

To help prevent bunions, choose shoes carefully. They should have a wide toe box — no pointy toes — and there should be space between the tip of your longest toe and the end of the shoe.

Your shoes should conform to the shape of your feet without squeezing or pressing any part of your foot.

Diagnosis

Your doctor can identify a bunion by examining your foot. After the physical exam, an X-ray of your foot can help your doctor determine the best way to treat it.

Treatment

Treatment options vary depending on the severity of your bunion and how much pain it causes.

Conservative treatment

Nonsurgical treatments that may relieve the pain and pressure of a bunion include:

• Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
• Padding. Over-the-counter, nonmedicated bunion pads or cushions may be helpful. They can act as a buffer between your foot and your shoe and ease your pain.
• Medications. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can help you control the pain of a bunion. Cortisone injections also might help.
• Shoe inserts. Padded shoe inserts can help distribute pressure evenly when you move your feet, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter supports can provide relief for some people; others require prescription orthotic devices.
• Applying ice. Icing your bunion after you've been on your feet too long or if it becomes inflamed can help relieve soreness and swelling. If you have reduced feeling or circulation problems with your feet, check with your doctor first before applying ice.

Surgical options

If conservative treatment doesn't relieve your symptoms, you might need surgery. Surgery is not recommended for cosmetic reasons; only when a bunion causes you frequent pain or interferes with your daily activities.

There are many surgical procedures for bunions, and no one technique is best for every problem.

Surgical procedures for bunions can be done as single procedures or in combination. They might involve:

• Removing the swollen tissue from around your big toe joint
• Straightening your big toe by removing part of the bone
• Realigning one or more bones in the forefoot to a more normal position to correct the abnormal angle in your big toe joint
• Joining the bones of your affected joint permanently

It's possible that you'll be able to walk on your foot right after a bunion procedure. However, full recovery can take weeks to months.

To prevent a recurrence, you'll need to wear proper shoes after recovery. For most people, it's unrealistic to expect to wear narrower shoes after surgery.

Talk to your doctor about what you can expect after bunion surgery.

Preparing for your appointment

You're likely to start by seeing your primary care doctor or a foot specialist (podiatrist or orthopedic foot specialist).

What you can do

To make the most of your time with your doctor, prepare a list of questions before your visit. Your questions might include:

• What's causing my foot problems?
• Is this condition likely to be temporary or permanent?
• What treatment approach do you recommend?
• Am I a candidate for surgery? Why or why not?
• Are there other self-care steps that might help?

Don't hesitate to ask any other questions.

What to expect from your doctor

Some questions your doctor might ask include:

• When did you begin having foot problems?
• How much pain do you have in your foot?
• Where is the pain?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• What type of shoes do you wear?