Bunions (Hallux Valgus)

Overview

What is a bunion?

A bunion is a bump that forms on the outside of the big toe. This foot deformity occurs from years of pressure on the big toe joint (the metatarsophalangeal, or MTP, joint). Eventually, the toe joint gets out of alignment, and a bony bump forms. The medical term for bunions is hallux abducto valgus.

Who might get a bunion?

Up to one in three Americans have bunions. The foot problem is more common in older adults, especially women. Bunions can form on one or both feet.

What are the types of bunions?

Bunions on the big toe are the most common. Other types include:

  • Congenital hallux valgus: Some babies are born with bunions.
  • Juvenile or adolescent hallux valgus: Tweens and teens between the ages of 10 and 15 may develop bunions.
  • Tailor’s bunion: Also called a bunionette, this bunion forms on the outside base of the little (pinky) toe.

What causes bunions?

Pressure from the way you walk (foot mechanics) or the shape of your foot (foot structure) causes your big toe to bend in toward the second toe. Bunions happen gradually over time. Standing for long periods and wearing ill-fitting, narrow shoes can make bunion pain worse, but they don’t cause the problem.

What are the risk factors for bunions?

You may be more likely to get a bunion if you have:

  • Family history of bunions due to inherited foot structure problems, like flatfeet.
  • Foot injuries.
  • Inflammatory diseases, such as rheumatoid arthritis.

What are the signs of bunions?

A bunion resembles a turnip — red and swollen. In fact, some sources say the word bunion comes from the Greek word for turnip. Other symptoms include:

  • Inability to bend the big toe, or pain and burning when you try to bend it.
  • Difficulty wearing regular shoes.
  • Corns or calluses (thickened skin).
  • Hammertoes (painful, tight toe tendons and joints).
  • Numbness in the big toe.

Symptoms and Causes

What causes bunions?

Pressure from the way you walk (foot mechanics) or the shape of your foot (foot structure) causes your big toe to bend in toward the second toe. Bunions happen gradually over time. Standing for long periods and wearing ill-fitting, narrow shoes can make bunion pain worse, but they don’t cause the problem.

What are the risk factors for bunions?

You may be more likely to get a bunion if you have:

  • Family history of bunions due to inherited foot structure problems, like flatfeet.
  • Foot injuries.
  • Inflammatory diseases, such as rheumatoid arthritis.

What are the signs of bunions?

A bunion resembles a turnip — red and swollen. In fact, some sources say the word bunion comes from the Greek word for turnip. Other symptoms include:

  • Inability to bend the big toe, or pain and burning when you try to bend it.
  • Difficulty wearing regular shoes.
  • Corns or calluses (thickened skin).
  • Hammertoes (painful, tight toe tendons and joints).
  • Numbness in the big toe.

Diagnosis and Tests

How are bunions diagnosed?

Your healthcare provider can diagnose a bunion by looking at it. You may also get X-rays to check for joint damage and bone alignment.

Management and Treatment

How are bunions managed or treated?

Bunions don’t go away. Treatment often focuses on relieving symptoms and may include:

  • Bunion pads and taping: Over-the-counter bunion pads can cushion the area and ease pain. You can also use medical tape to keep the foot in the correct position.
  • Footwear changes: Switching to shoes with wide, deep toe boxes can take pressure off of your toes. You may be able to use a stretching device to widen shoes you already own.
  • Orthotic devices: Over-the-counter or custom-made shoe inserts (orthotics) can help to control alignment issues such as pronation that may be contributing to bunion formation. You can also place a spacer between the big toe and second digit. Some people find relief by wearing a splint at night to keep the big toe straight.
  • Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) both oral and topical can be combined with ice packs help with pain and swelling.
  • Physical therapy: Massage, physical therapy and ultrasound therapy can break up soft-tissue adhesions to reduce pain and inflammation. There are actually exercises that can help improve muscle strength around the bunion and can modestly improve alignment.
  • Injections: Steroid injections may reduce pain and swelling but may also be damaging if used too often or injected into the joint itself. This is often a late treatment of bunions when trying to avoid surgery.
  • Surgery: If nonsurgical treatments don’t help, and walking becomes extremely painful, your provider may recommend surgery. This procedure is called a bunionectomy. Your provider removes the bunion and realigns bones to bring the big toe back into the correct position.

Prevention

How can I prevent a bunion?

Proper-fitting footwear is key to preventing bunions or keeping an existing bunion from getting worse. Your healthcare provider can offer tips on how to select appropriate shoes. In general, you should buy shoes with a wide toe box and soft soles. Avoid shoes that are narrow and pointed at the tip, and high heels that put pressure on the front of the foot. If you have flatfeet or another inherited structural foot problem, custom-fitted orthotics can help prevent, or slow the progression of, bunions.

Outlook / Prognosis

What are the complications of bunions?

Having a bunion may increase your risk of:

What is the prognosis (outlook) for people with bunions?

Without the right care, like changing your footwear or using orthotics, bunions can get worse over time. If you have severe pain when you walk or stand, you may become sedentary (inactive), which isn’t good for your health or quality of life. Most people get symptom relief with over-the-counter aids or through treatments at a medical office. If needed, surgery can help.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Difficulty walking.
  • Lack of movement in the big toe.
  • Severe inflammation or redness in toe joints.
  • Signs of infection after surgery, such as fever.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • Why did I get a bunion?
  • What are the best treatments for bunions?
  • What can I do to lower the risk of getting a bunion on my other foot?
  • How can I lower the risk of other foot problems like calluses and corns?
  • What complications can occur if I do not treat my bunion?

A note from Cleveland Clinic

Bunions are very common. While over-the-counter bunion pads and pain relievers ease symptoms, you should see a healthcare provider. Your provider can recommend other treatment options, such as shoe gear modifications, physical therapy, medications and orthotics. Treatments can reduce pain and stop bunion symptoms from getting worse. If the pain becomes severe, surgery to remove the bunion and realign the big toe can help you get moving again.

Last reviewed by a Cleveland Clinic medical professional on 12/10/2020.

References

  • American Academy of Orthopaedic Surgeons. . Accessed 12/11/2020.Bunions (https://orthoinfo.aaos.org/en/diseases--conditions/bunions/)
  • The American College of Foot and Ankle Surgeons. . Accessed 12/11/2020.Bunions (https://www.foothealthfacts.org/conditions/bunions)
  • American Podiatric Medical Association. Accessed 12/11/2020.What Is a Bunion? (https://www.apma.org/bunions)
  • Merck Manual. . Accessed 12/11/2020.Bunion (https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/foot-problems/bunion)
  • U.S. National Library of Medicine. . Accessed 12/11/2020.Bunion (https://ghr.nlm.nih.gov/condition/bunion)

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