What is a bunion and what causes them?

Hallux valgus, often known as “a bunion” refers to a bump on the inside of the big toe. The toe tilts over towards the smaller toes and a firm lump appears which is a combination of bony and soft tissue swelling. The bony lump is the end of the first metatarsal bone.

Bunions are commoner in women than in men, and tend to run in families. Bunions do occur in cultures in which shoes are not worn, but much less commonly. Shoes which squeeze the big toe or do not fit properly, or have an excessively high heel, can probably help to cause the deformity especially in people who are at higher risk anyway.

What are the main problems with bunions?

The main problem is usually the pressure of the shoe over the prominence, which causes discomfort and/or pain. Sometimes the skin over the lump becomes red, blistered or infected. The foot may become so broad that it is difficult to get wide enough shoes.

The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place. Furthermore the big toe does not work as well with a bunion, and the smaller toes have to take more of the body weight whilst walking. This can cause pain under the ball of the foot. Sometimes arthritis (wear and tear) develops in the deformed joint, causing pain.

What are the treatment options?

Many people with bunions are quite comfortable if they wear wide, well-fitting shoes and give them time to adapt to the shape of their feet. A small pad over the bony prominence, which can be bought from a chemist or chiropodist, can take the pressure of the shoe off the bunion. High heels tend to squeeze the foot into the front of the shoe and should be avoided.

Ultimately, if you cannot find a shoe to fit your foot, we need to consider an operation to make your foot fit the shoe. An operation will not give you an entirely normal foot, but it will correct the tilting of the big toe, and remove the prominence.

There are a lot of different operations for bunions, depending on the severity of the deformity, the shape of your foot and whether arthritis has developed in the big toe joint.

Research shows that 85% of people who have bunion corrections are satisfied with the results.

What are the complications of surgery?

The big toe is usually stiffer than before. For most people this does not matter, but for athletes or dancers it is very important.

In some people the big toe slowly tilts back toward the original position and occasionally this requires further surgery. In some cases the toe can tilt the other way, although this is much less common, and requires surgery if problematic. Infections in the wound, and minor damage to the nerves of the toe can occur in any foot surgery. Usually these are minor problems that get better quickly.

This may sound like a lot of possible problems, but in fact most people do not get them and are satisfied with their bunion surgery.