Overview

The big toe is held straight by soft tissue and small bones (sesamoids) under the joint. When the big toe starts to point in towards the other toes, and the metatarsal (long bone before this joint) begins to move out, we see a bony prominence or lump. This is called a bunion (also known as Hallux Valgus).

The NHS website has more information about bunions. 

Causes of bunions

Bunions are often inherited but can also occur when there is a lot of movement in the foot joints. Narrow, pointed footwear and high heels can also cause bunions to occur more quickly.

Signs and symptoms

Bunion symptoms can vary. Some are painless, and others can be painful and limit activity. The size of the bunion usually does not affect how painful the bunion might be. Usually, there will be pain when wearing tight shoes which press on the bunion.

Diagnosis

Bunions are usually are diagnosed clinically following a physical examination. Sometimes, the podiatrist (foot specialist) may request imaging such as X-rays, or ultrasounds, to rule out other causes of pain. X-rays will be requested when referring for a surgical opinion so the surgical team can decide which procedure will be the most suitable.

Treatment options

Treatment options depend on your symptoms. If bunions are not painful there is no need for treatment. You cannot get rid of bunions or stop them getting worse without surgery, however there are non-surgical treatments which may help ease painful bunions. Surgery is not offered just for cosmetic purposes and should be considered carefully as, with all surgeries, there are some risks involved. 

You can discuss all treatment options with your podiatrist to decide the most appropriate treatment for you.

Footwear

Wearing wide fitting footwear such as EE or EE+ widths can accommodate the bunion shape and reduce compression and rubbing.  Avoid high heels, pointed shoes, and narrow footwear. You can read our information about choosing shoes, please ask your podiatrist for a copy. 

Bunion sleeves and pads

There are several kinds of bunion sleeves and cushioning pads made from foam and gel to ease rubbing from footwear. They are available to buy from supermarkets and pharmacies and may help with your pain. Bunion ‘correction’ devices are misleading as there is no evidence that these will change the appearance of your bunion.

Foot orthoses (insoles)

Your podiatrist may look at your gait (the way you walk) and the way you stand, and may decide that you would benefit from specialist insoles or foot orthoses. There is limited evidence for use of insoles with bunions as they will not correct the bunion but may improve your pain.

Steroid injection

If your bunion pain is particularly severe, steroid injections may be considered for targeted short term pain relief. These are not normally used as an initial treatment, but might be considered as an alternative to surgery.

Surgery 

Surgery is the only way to correct the bunion shape. Surgery might be an option when bunions are painful, or limit activity, and when the pain does not improve with appropriate footwear. If you are considering surgery, you will be referred to a podiatric or orthopaedic surgeon. Your options will be discussed with the surgical team.

Things you can do to help

Lifestyle changes

If you are overweight, losing weight will help as it will reduce the amount of pressure going through your feet when you walk. If you think you need more help with weight loss, please discuss this with your podiatrist or GP.

More information and support

The NHS website has more information about bunions. 

The Royal College of Podiatry have information for patients about different types of foot conditions.

https://rcpod.org.uk/