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A bunion is an enlargement of bone or tissue around the
joint at the base of the big toe. The big toe may turn toward the second toe. The tissues around the joint may be
swollen and tender.
A bony bump at the base of the little toe is
called a bunionette or tailor's bunion. The little toe also bends inward, and
the joint swells or enlarges.
You may get bunions
All of these may put pressure on the big toe joint. Over
time, the constant pressure forces the big toe out of alignment, bending it
toward the other toes.
Your bunion may not cause
any symptoms. Or you may have pain in your big toe, red or irritated skin over
the bunion, and swelling at the base of the big toe. The big toe may point
toward the other toes and cause problems in other toes, such as
hammer toe. A bunionette can cause similar symptoms at
the base of the little toe.
Your doctor will ask
questions about your past health and carefully examine your toe and joint. Some
of the questions might be: When did the bunions start? What activities or shoes
make your bunions worse? Do any other joints hurt? The doctor will examine your
toe and joint and check their range of motion. This is done while you are
sitting and while you are standing so that the doctor can see the toe and joint
at rest and while bearing weight.
often used to check for bone problems or to rule out other causes of pain and
swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid
from a joint for testing), are sometimes done to check for other problems that
can cause joint pain and swelling. These problems might include gout,
rheumatoid arthritis, or joint infection.
Currently, no strong
evidence points to the best treatment for bunions. But in most cases, you can
treat them at home. This includes taking medicine you can buy without a
prescription to relieve toe pain. It also helps to wear shoes that do not hurt
your feet. For example, avoid high heels or narrow shoes. You can wear pads to
cushion the bunion, and in some cases, you can use custom-made shoe inserts
Avoid activities that put pressure on your big toe
and foot. But don't give up exercise because of toe pain. Try activities that
don't put a lot of pressure on your foot, such as swimming or bicycling.
Surgery to correct a bunion may be an option if other treatment does not
relieve pain. There are different types of surgery for bunions. You and your
doctor can decide which one is best for you.
Proper footwear may
prevent bunions. Wear roomy shoes that have wide and deep toe boxes (the area
that surrounds the toes), low or flat heels, and good arch supports. Avoid
tight, narrow, or high-heeled shoes that put pressure on the big toe
Medicine will not prevent or cure bunions.
Learning about bunions:
Living with bunions:
Health Tools help you make wise health decisions or take action to improve your health.
Bunions may be caused by foot mechanics that result in
too much pressure on the joint at the base of the big toe (metatarsophalangeal joint). An abnormal
foot motion called
excessive pronation, having certain foot shapes such as
flatfoot, and wearing shoes that squeeze the toes
together or shift weight to the toes (such as high-heeled shoes) may all
contribute to the pressure. Over time, the constant pressure forces the big toe
out of alignment, gradually bending it toward the other toes (displacement).
bunionette, or tailor's bunion, is one that develops
at the base of the little toe. When the long bone that connects to the toe
(metatarsal) bends away from the foot, the little toe
bends inward and the joint swells or enlarges.
Other factors that
can lead to a bunion include:
bunion may not cause any symptoms. If you do have
symptoms, they may include:
bunionette causes symptoms that occur at the base of
the little toe.
Bunions and their symptoms develop gradually. They
are sometimes confused with symptoms of
gout, but gout pain comes on suddenly and can be more
severe than bunion pain. Gout pain and swelling tend to occur in episodes,
while bunion pain is more constant. Unlike a bunion, gout does not usually
cause joint deformity. For more information, see the topic
Bunions on the
big toe often begin when an abnormal foot motion called
excessive pronation transfers weight to the inner edge of the sole of the foot.
This and other factors, such as having
flatfoot and wearing tight-fitting shoes, can result
in too much pressure on the joint at the base of the big toe, causing the
big toe to bend in toward the smaller toes.
A bunion can affect
the other toes. As a result of the pressure of the big toe moving toward other
toes, you may develop:
A bunion can increase the risk of
osteoarthritis in the big toe joint.
Bunions can develop at any
time and are found in both children and adults. You are at increased risk for
bunions if you:
Call your doctor
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition
without using medical treatment. Watchful waiting may be appropriate if bunion
pain is not severe. In this case, try home treatment, such as using ice to
relieve pain or wearing comfortable footwear. If there is no improvement after
2 to 3 weeks of home treatment, call your doctor.
Symptoms of a bunion can be evaluated and
To prepare for your appointment, see the topic Making the Most of Your Appointment.
If you have a bunion, you will notice a bump on your big toe
joint. The big toe may turn toward the second toe (displacement), and the
tissues surrounding the joint may be swollen and tender.
are diagnosed through a medical history and physical exam. This may
often used to find out the degree of bone deformity or to rule out other
causes of pain and swelling. If surgery is being considered, X-rays can help
your doctor determine what type of surgery will be most helpful in treating the
symptoms. X-rays usually are done while you are standing so that the foot is
bearing weight. In some cases, magnetic resonance imaging (MRI), computed tomography (CT scan), or
a bone scan is also used.
such as blood tests or
arthrocentesis (removal of fluid from a joint for
analysis), are sometimes done if other conditions that can cause joint pain and
swelling are suspected, such as
rheumatoid arthritis, or joint infection.
If you have a bunion but do not have
pain or discomfort, treatment may not be necessary. The goals of treatment for
bunions are both to relieve toe pain so that it does not limit daily activities
and to prevent the bunion from getting worse.
Most bunions can be
treated at home. In some cases, surgery is considered.
usually is used to decrease pressure on the big toe and relieve pain. Treatment
Physical therapy, splints, or braces have not been
proved to successfully treat bunions. But these treatments may be helpful for
If nonsurgical treatment has
not relieved toe pain and you aren't able to do normal daily activities, or if
you have a severe bunion, you may want to consider surgical treatment.
Bunion surgery is done to help restore normal
alignment to the toe joint and relieve pain.
different types of bunion surgery—the best type of
surgery for you depends on how severe your bunion is and how experienced your
surgeon is. Look for a surgeon who does many different types of bunion surgery
on a regular basis. Each bunion is different, and surgery needs to be tailored
to each case.
Proper footwear can help reduce the risk of bunions.
Preventing too much rolling inward of the foot (excessive pronation) during walking or running may help prevent bunions. Excessive
foot pronation has been linked to bunion formation. You may be able to prevent
excessive pronation by wearing supportive shoes or using arch supports. If you
still have excessive pronation, your doctor may suggest that you have custom
orthotic shoe inserts made for you.
Home treatment can help relieve toe pain and may prevent a
bunion from getting worse. Home treatment includes:
To relieve toe pain:
For children with bunions, using orthotic insoles to
correct a walk where the foot rolls inward (excessive pronation) is questionable.
Some studies show that bunions in children may not be related to
Children who have bunions should see a doctor if foot
pain is limiting their activity. In some cases, the doctor may recommend
Medicine will not prevent or cure bunions. But it may relieve
pain and inflammation and allow you to do your normal daily activities.
If your toe pain is not severe, you can try nonprescription medicine
first, such as:
Bunion surgery generally involves making an incision in the top
or side of the big toe joint area and removing or realigning soft tissue and
bone. The goals of surgery for bunions are to:
You may have to consider surgery if your bunion results in
persistent, severe pain that limits your daily activities or if you have a
severe foot deformity.
Surgery is not recommended if you:
Athletes, children, and people with certain health problems are generally advised to take a conservative, nonsurgical
approach when considering bunion treatment.
Joint replacement surgery is not often done to repair a bunion. If your doctor recommends joint replacement, get a second opinion.
Some issues to consider when deciding about bunion surgery:
Treatment options for bunions include arch supports, custom-made
orthotics, and custom-made shoes. All of these
temporarily change the way the bones, muscles, and ligaments of the foot work
together. They will not cure the bunion, but they may help relieve some
structural problems that are contributing to it by:
Arch supports are available without a prescription.
Orthotics and custom-made shoes are available with a prescription and are
professionally fitted to your foot.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American College of Foot and Ankle Surgeons provides
information on surgery and shoe selection as well as the care and treatment of
heel, toe, ankle, nerve, tendon, nail, and skin conditions. You can also look up and learn about sports injuries, diabetic foot problems, arthritis, and resources in your local area.
The American Orthopaedic Foot and Ankle Society (AOFAS)
provides information on a variety of topics, including foot care for adults,
children, and people who have diabetes; proper shoe fit; and how to select
children's shoes and sports shoes. Some information is available in several
languages besides English.
The American Podiatric Medical Association (APMA)
provides information about foot and ankle injuries, sports-related foot
concerns, surgical and nonsurgical treatment of foot problems, special medical
issues such as diabetes, and resources in your local area. Some information is
available in Spanish.
Ferrari J (2009). Bunions, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Other Works Consulted
American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Hallux valgus. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 819–821. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Perera AM, et al. (2011). The pathogenesis of hallux valgus. Journal of Bone and Joint Surgery, American Version, 93(17): 1650–1661.
Vanore JV, et al. (2003). Diagnosis and treatment of
first metatarsophalangeal joint disorders. Section 1. Hallux valgus.
Journal of Foot and Ankle Surgery, 42:(3) 112–123.
August 5, 2013
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
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