Bunions

What is a bunion?

A bunion, known clinically as hallux valgus, is a change at the base of your big toe. The toe leans towards the other toes, and a bony bump appears on the inside of the foot¹. Strictly, "bunion" means the inflamed tissue over that bump, but the two terms are often used to mean the same thing¹.

It's common, and becomes more common with age. Around 23% of adults aged 18–65 and 35.7% of people over 65 are affected², though a more recent review gave lower figures³. It's more common in women than in men³.

What causes bunions, and who gets them?

There's no single proven cause. It's most likely a mix of how your foot is built and moves, loose (hypermobile) joints and genetics⁴, along with an imbalance in the muscles and ligaments of the foot⁵. Bunions tend to run in families⁶. Being female and getting older are linked with having a bunion and with it being more severe⁷. Inflammatory joint disease is also linked with them⁴.

Narrow or high-heeled shoes are widely thought to contribute, but the evidence is less clear-cut than many people expect, and the part played by heel height alone is unclear⁴⁸. It's fair to see shoes as a possible contributor, not a proven cause.

What does a bunion feel like, and how is it diagnosed?

Common signs are a bony lump on the inside of the big toe joint, the toe leaning towards the second toe, and pain, stiffness and swelling in the joint⁹. The skin over the bump can be red or hard, and comfortable shoes can be hard to find⁹. Pain is usually worse when walking or wearing shoes¹⁰, though many people have no pain at all¹¹.

A podiatrist or GP can make the diagnosis. It relies on the clinician's experience, because bunions vary in how they look and show up on X-ray³. The angle of the toe is often measured to gauge how far it has moved¹².

Other problems can look similar: gout (red, hot, swollen skin over the joint that comes and goes)¹⁰, an inflammatory arthritis¹³, or a stiff big toe joint called hallux rigidus in older adults⁷. If the joint keeps flaring up red, hot and swollen, see your GP.

What can I do first?

Start with your shoes. Changing footwear is described as the mainstay of treatment, and many people report less discomfort once their shoes fit properly¹⁴. Wide-fitting, low-heeled, extra-depth shoes with soft uppers give the toe and the bump room and reduce pressure¹⁵. Try to avoid narrow toe boxes and high heels¹⁴.

Low-profile bunion pads, a toe spacer and simple pain relief can also help¹⁴. A pharmacist can advise on pain relief such as paracetamol or ibuprofen¹⁰. An ice pack wrapped in a tea towel, held on the bunion for up to 5 minutes at a time, is another option¹⁰. Don't ice numb skin or open wounds, and stop if pain, swelling or skin soreness increases.

A podiatrist can advise on insoles, toe spacers and toe splints¹⁰. Insoles may be suggested if your bunion comes with a flat foot or a stiff, sore big toe joint¹⁵. Non-surgical treatments are more likely to ease pain than to change the angle of the toe, and how well they work isn't certain¹⁶.

What if simple care isn't enough?

If pain hasn't improved after a few weeks of home care, ask your GP or a podiatrist to review it¹⁰. People who haven't improved with first-line care can be referred on¹⁷. Which option works best at this stage isn't clear yet.

If surgery is ever considered, the blood flow, feeling and movement in your foot should be checked first⁵.

Will it get worse, and what can I do about it?

A bunion often gets worse over time, but how quickly varies a lot from person to person⁶. No treatment is known to slow or stop it¹⁸. Comfortable shoes, pads and toe inserts ease symptoms but won't stop it advancing⁶, and there isn't enough good evidence that insoles slow it down¹⁹. As a bunion worsens, the smaller toes, especially the second, can become deformed and painful⁶.

Many people never need treatment¹¹. Wide, low-heeled shoes with soft uppers remain a sensible choice for comfort¹⁵.