Bunions are a common cause of pain and problems with shoe fitting in the forefoot. A bunion, also known as hallux valgus, appears as a bony prominence on the inner side of the foot at the base of the big toe, often with the big toe drifting towards the second toe.
Mr Edward Dawe is a Consultant Trauma and Orthopaedic Surgeon specialising exclusively in foot and ankle surgery. Bunions are assessed clinically and, where needed, weight-bearing X-rays can help clarify the severity of the deformity and guide treatment planning.
What are bunions?
A bunion is a deformity affecting the big toe joint. The prominence on the inner side of the foot is only one part of the problem. The joint alignment changes, the big toe may drift towards the second toe, and the pattern of pressure through the forefoot can also change.
Some bunions are mainly a cosmetic concern, but others can cause pain, rubbing in footwear, swelling, problems with shoe fitting, difficulty with activity, and problems in the lesser toes.
Symptoms of bunions
Symptoms can include:
- pain or tenderness around the base of the big toe
- problems with shoe fitting
- redness, rubbing or swelling over the prominence
- pressure symptoms in the forefoot
- the big toe drifting towards the second toe
- associated lesser toe problems in some patients
What causes bunions?
Bunions usually develop for more than one reason. Foot shape, joint mechanics, family tendency, soft tissue balance and footwear can all play a part. They are common and can gradually become more noticeable over time.
Not every painful big toe joint is a bunion. Arthritis in the big toe joint and other forefoot conditions can sometimes cause similar symptoms, so assessment is important before treatment is planned.
How are bunions assessed?
Assessment usually involves discussing your symptoms, examining the position of the big toe and forefoot, and considering how much the bunion is affecting footwear and day-to-day activity.
Weight-bearing X-rays are often helpful when symptoms are significant or when surgery is being considered. These can show the shape of the bunion, the alignment of the joint and any associated changes elsewhere in the forefoot.
Non-surgical treatment for bunions
Non-surgical treatment is often tried first, particularly when symptoms are mild or intermittent. This may include wider footwear, activity modification, pads or bunion protectors, and simple measures to reduce rubbing over the prominence.
These measures may help symptoms, but they do not correct the underlying deformity. When a bunion remains painful or continues to cause problems with shoe fitting and activity, surgery may be considered.
When might bunion surgery be considered?
Bunion surgery may be considered when symptoms persist despite appropriate non-surgical treatment. The aim is usually to reduce pain, improve function and allow more comfortable footwear.
A range of surgical techniques may be used depending on the type and severity of the bunion. Mr Edward Dawe commonly uses minimally invasive, or keyhole, bunion surgery where appropriate, although not every bunion is suitable for the same procedure.
If surgery is being considered, the type of bunion procedure, recovery, risks and expected outcomes should be discussed in detail as part of treatment planning.
Frequently asked questions
A bunion is a deformity affecting the big toe joint, with a prominence on the inner side of the foot and drift of the big toe towards the second toe.
Yes. Wider footwear, activity modification, pads or protectors and other simple measures may help symptoms, although they do not correct the underlying deformity.
Not always, but weight-bearing X-rays are often helpful when symptoms are significant or when surgery is being considered.
Bunion surgery may be considered when symptoms persist despite appropriate non-surgical treatment and the bunion continues to cause pain, problems with shoe fitting or functional problems.
No. Minimally invasive, or keyhole, bunion surgery is suitable for many patients, but the best procedure depends on the type and severity of the bunion and individual clinical factors.
They can. Some bunions remain fairly stable, while others gradually become more prominent and more symptomatic over time.