Author: Chloe Wilson - BSc(Hons) Physiotherapy
A foot bunion is a common cause of pain caused by deformity of one of the toe bones. It most commonly affects the big toe, known as hallux abducto valgus, but can also affect the little toe, known as a bunionette.
The classic presentation is a large bump on the outer side of the big toe that is red, swollen and painful caused by the toe deviating across towards the second toe. Left untreated, the condition usually gets gradually worse, so it is important to get treatment early on else you may end up needing surgery.
Here we will find an overview of the common causes and symptoms of foot bunions, the best treatment options including surgery and how to prevent them from developing in the first place or coming back in the future.
A foot bunion is where the big toe gradually deviates inwards towards the second toe and in severe cases may even start to cross over the top or underneath. As the top of the toe moves inwards, the base of the toe (the knuckle part), pushes outwards producing the characteristic lump on outer side of the big toe.
The medical term for a foot bunion at the big toe is a hallux abducto valgus, or hallux valgus. “Hallux” means big toe, “abducto” means to move away from the midline and “valgus” refers to the abnormal angle of the toe.
Bunions can also occur in the little toe, where they are known as a bunionette or tailors bunion, but these are much less common.
There are a couple of problems that can develop alongside bunions. Firstly, the sesamoid bones (two small pea-shaped bones) that sit under the base of the big toe can get shifted out of place.
Secondly, if the bursa (small fluid filled sac) that sits over the big toe gets irritated it may become inflamed, known as bursitis.
There is some debate about the main causes, but they tend to fall into two categories:
There is a definite genetic link, meaning that if someone in your family suffers from a hallux abducto valgus, there is a high chance that you will too. It may be due to an abnormal foot position such as flat feet, or a medical condition such as hypermobility (where your joints are overly flexible) or arthritis (e.g. rheumatoid arthritis or gout).
Poorly fitting shoes are thought to be the other common cause. Frequently wearing tight fitting shoes, especially shoes with pointed toes or high heels places excessive pressure on the big toe squashing it into the classic hallux abducto valgus position.
There is much debate as to which is the major cause, but it is likely to be a combination of the two. Studies have shown that in cultures where people don’t wear shoes but are habitually barefoot, there are very few cases of foot bunions indicating a strong correlation with shoe wear. Bunions are more common in females, most likely due to choice of footwear.
Painful bunions are more common with increasing age. They develop gradually overtime from repeated force through the big toe and left untreated, become more pronounced with worsening symptoms.
The most classic symptom of a foot bunion is the change in position of the toe. This will develop gradually and progressively, rather than coming on suddenly. At first, there may not be any discomfort associated with the changing to position, but after a while it may well become a painful bunion.
You can find out more about, including how symptoms progress in the foot bunion symptoms section.
There are a number of different treatment options which can be split into two groups:
Treatment aims to reduce the pain, prevent foot bunions from becoming worse and avoid the need for surgery. Changing your footwear is the best place to start. Medication and ice can help to reduce the pain and inflammation associated with the condition.
Another thing that can really help is orthotics - specially designed splints, such as the bunion protector shown here, to help to hold your toe in the correct position to help stop it from deviating out to the side.
You can find out all about these different treatment options and more in the Bunions Treatment section. The sooner you start these treatment methods, the more your
symptoms will reduce and the more likely you'll be able to avoid surgery.
If non-surgical treatments are not working and your painful bunions are affecting your day-to-day activities, you may need to have surgery to correct the hallux abducto valgus.
There are a number of different types of surgery, but the two most common are:
a) Osteotomy: where part of the bone is removed to realign the toes
b) Fusion: where the joint at the bottom of the toe is fused - this is usually only done for more severe cases
It usually takes about six to eight weeks to recover from surgery, although swelling may persist for six months, and they have a success rate of approximately 85%.
You can find out lots more about the different types of surgery, how they are performed and the recovery process in the Bunion Surgery section.
The simplest way to reduce your chance of developing foot bunion or bunionette problems is to wear good-fitting shoes. Avoid high heels as they push your feet forwards to the front of the shoe where they get squashed. Also avoid narrow fitting shoes, especially those that are pointed at the front with a narrow toe box as again, these place pressure through the toes pushing them inwards. Shoes should be comfortable and leave enough room for you to wiggle your toes. Remember, they rarely affect non-shoe wearing people.
Exercising your feet can also help. By strengthening the foot muscles you can improve your foot position which can help reduce foot bunion problems. Simple exercises like picking up small objects with your toes can help – visit the foot exercises section for more information.
You can find out loads more about bunions in the following sections:
Whilst a foot bunion or bunionette is one of the most common causes of toe pain, if this is not sounding quite like your problem, visit the Toe Pain section. If you want some help working out what is causing your pain, visit the Foot Pain Diagnosis section.