Bunions (Hallux Valgus)
A bony bump at the base of the big toe, as the toe drifts towards the others. Very common, often runs in families, and only needs surgery if it really hurts.
Quick answer: A bunion (hallux valgus) is a bony lump on the side of the foot where the big toe leans towards the other toes. It’s common, especially in women and older people, and often runs in families. Wide, low-heeled shoes, pads and pain relief help most people. Surgery straightens the toe when pain affects daily life, but recovery takes months and it isn’t done for looks.
How common. A large review found bunions in about 23% of adults aged 18 to 65 and about 36% of people over 65. They’re more than twice as common in women (30%) as men (13%).
Causes. Not fully understood. Inherited foot shape is the biggest factor. Tight, narrow or high-heeled shoes make bunions more likely and more painful. Osteoarthritis, rheumatoid arthritis and foot injuries can also cause them.
Symptoms.
- a hard lump on the side of the foot at the big toe joint
- the big toe angling towards the other toes, sometimes crowding the second toe
- red, swollen or hardened skin over the lump
- pain when walking or in shoes, and trouble finding shoes that fit
Big bunions don’t always hurt, and small ones sometimes do.
How it’s diagnosed. By looking at your foot. X-rays are taken if surgery is being considered. Sudden redness and severe pain in the big toe joint is more likely gout.
Treatment
Nothing except surgery removes a bunion, but most people get comfortable with the right shoes and simple measures.
- Step 1 · Self-careBetter shoesWide, deep toe box, low heel, soft sole. Avoid pointed, tight or high-heeled shoes.
- Works
- Reduces pressure and pain for most people
- Access
- Free to cheap
- Watch for
- Bunions can still slowly progress.
- Step 2 · PharmacyBunion pads, ice and pain reliefGel or felt pads stop rubbing. An ice pack wrapped in a towel for up to 5 minutes, and paracetamol or ibuprofen for flares.
- Works
- Eases pain and skin irritation
- Access
- Over the counter
- Watch for
- With diabetes, see a podiatrist rather than self-treating skin problems.
- Step 3 · Allied healthPodiatristInsoles, toe spacers or splints, and foot exercises to keep the joint moving.
- Works
- Can ease pain; don’t straighten the toe permanently
- Access
- Podiatrist (GP care plan may help with costs)
- Watch for
- Splints and spacers help comfort, not the shape of the bone.
- Step 4 · SpecialistSteroid injectionInto the big toe joint for a painful flare.
- Works
- Short-term relief
- Access
- GP or specialist
- Watch for
- Not a long-term fix; limited number of injections.
- Step 5 · SpecialistSurgery (osteotomy)The bone is cut and realigned, often fixed with screws. Usually a day procedure.
- Works
- Straightens the toe and eases pain for most
- Access
- Orthopaedic surgeon or podiatric surgeon
- Watch for
- Feet raised for 2 weeks, no driving for 6 to 8 weeks, 2 to 12 weeks off work, no sport for 3 to 6 months. Stiffness and recurrence are possible.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Night splints and toe straighteners to “fix” a bunionMay ease discomfort, but won’t correct the bone.
- Surgery purely for appearanceNot recommended; recovery is long and the toe may end up stiff or sore.
Living with it
- Keep active; choose low-impact exercise if walking hurts.
- Keep a healthy weight to ease the load on your feet.
- If you have diabetes, check your feet daily and see a podiatrist regularly.
See your GP if
- Pain hasn’t improved after a few weeks of better shoes and self-care
- Pain affects your walking, work or exercise
- The bunion is getting worse or your second toe is being pushed out of place
- You have diabetes or poor circulation
Get urgent help if the skin over a bunion breaks down, oozes, or becomes red, hot and spreading, especially with fever or if you have diabetes. This can be an infection: see a doctor the same day, or call 000 (Australia) or your local emergency number if you feel very unwell.
Outlook. Bunions usually progress slowly. Most people manage well with shoes and simple care. Surgery helps most people with painful bunions, but recovery takes months and bunions can return.
Common questions
What causes bunions?
Mainly inherited foot shape. Tight or high-heeled shoes make them more likely and more painful, but don’t cause them on their own.
Can bunions go away without surgery?
No. Shoes, pads and exercises ease pain but don’t reverse the bone change.
Do toe spacers fix bunions?
They may make the toe more comfortable, but won’t straighten it permanently.
How long is recovery after bunion surgery?
Usually 6 to 8 weeks before driving, 2 to 12 weeks off work, and 3 to 6 months before sport.
Are bunions hereditary?
Often. Many people with bunions have a parent or grandparent with them.
Evidence and more information
- NHS: Bunions
- Healthdirect: Bunions
- Nix et al, J Foot Ankle Res 2010: Prevalence of hallux valgus in the general population
- NHS Tayside: Hallux valgus referral guidance
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