MusculoskeletalICD-10: M20.1Very common; affects a large proportion of adults, particularly women and older people

Bunion

Also known as: Hallux valgus

A bunion is a bony bump that forms on the joint at the base of the big toe when the toe drifts toward the second toe and the joint pushes outward. It develops gradually, usually over years, as the bones of the forefoot shift out of alignment. Bunions tend to run in families and are far more common in women, partly because narrow, pointed or high-heeled shoes squeeze the toes together. The bump itself may be painless, but it often rubs against shoes, becomes red and swollen, and can lead to arthritis in the joint, calluses and hammer toes. Roomier footwear, padding and orthotics relieve symptoms for many people; surgery can realign the joint when pain limits daily life.

At a Glance

Common symptoms
A visible bump on the outside of the base of the big toe, The big toe angling toward, overlapping or crowding the second toe, Soreness, redness or swelling over the joint
Main treatments
Wearing wide, soft shoes with a roomy toe box and low heel, Bunion pads, toe spacers or moleskin to reduce friction and pressure, Over-the-counter pain relievers and ice after being on your feet
Category
Musculoskeletal · Very common; affects a large proportion of adults, particularly women and older people
See a doctor if
Persistent big toe or foot pain that affects walking or daily activities

Symptoms

A visible bump on the outside of the base of the big toe
The big toe angling toward, overlapping or crowding the second toe
Soreness, redness or swelling over the joint
Pain when walking or wearing shoes, especially narrow ones
Corns or calluses where the toes rub together
Stiffness and reduced movement of the big toe
A smaller bump on the outside of the little toe (a bunionette) in some people

Causes

  • Inherited foot structure, such as flat feet, loose ligaments or a long first metatarsal
  • Shoes that are too narrow, tight or high-heeled, pushing the toes together
  • Muscle imbalance and abnormal walking mechanics that stress the big toe joint
  • Inflammatory arthritis such as rheumatoid arthritis
  • Previous injury to the foot
  • Neuromuscular conditions that affect foot alignment

Risk Factors

  • Being female
  • A family history of bunions
  • Regularly wearing narrow, pointed or high-heeled shoes
  • Flat feet or over-pronation
  • Rheumatoid arthritis or other inflammatory joint disease
  • Older age and jobs that involve long hours standing

Diagnosis

  • Physical examination of the foot while standing and walking
  • Assessment of big toe alignment, joint movement and skin changes
  • Weight-bearing X-rays to measure the angle of the deformity and check for arthritis
  • Evaluation of footwear and gait

Treatment

  • Wearing wide, soft shoes with a roomy toe box and low heel
  • Bunion pads, toe spacers or moleskin to reduce friction and pressure
  • Over-the-counter pain relievers and ice after being on your feet
  • Custom orthotic inserts to improve foot alignment and reduce stress on the joint
  • Night splints, which can ease discomfort though they do not correct the bone position
  • Surgery (bunionectomy or osteotomy) to realign the bones when pain persists despite conservative care and limits activity
  • Supportive: foot-strengthening and toe-spreading exercises and maintaining a healthy weight

Prevention

  • Choose shoes that match the shape of your foot with plenty of room for the toes
  • Limit time in high heels and pointed shoes
  • Have your feet measured regularly and buy shoes that fit, not ones you hope will stretch
  • Use orthotics if you have flat feet or over-pronate
  • Keep your feet strong and flexible with regular exercises
  • Seek advice early if you notice the big toe starting to drift

When to See a Doctor

  • Persistent big toe or foot pain that affects walking or daily activities
  • A bump that is enlarging or a toe that is increasingly crowding the others
  • Difficulty finding shoes that fit comfortably
  • Reduced movement of the big toe
  • Redness, warmth, an open sore or signs of infection over the bunion, especially if you have diabetes

Frequently Asked Questions

Related Conditions

Hammer Toe

Musculoskeletal

Flat Feet

Musculoskeletal

Osteoarthritis

Musculoskeletal

Rheumatoid Arthritis

Autoimmune

Gout

Musculoskeletal

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