Foot Conditions A-Z

Bunion

A bunion (hallux valgus) is a bony protrusion that forms most often in the joint at the base of the big toe.  The big toe joint enlarges and forces the toe to point back toward the other toes, encroaching on them and sometimes overlapping them.  This abnormal positioning puts pressure on the big toe joint, causing it to grow outward beyond the normal profile of the foot, resulting in pain and fitting difficulties in normal footwear.  Bunions can also occur in the fifth toe joint (the little toe).  Bunions in this location are called “tailor’s bunions” or “bunionettes.”

Bunions are one of the most common foot issues and occur much more frequently in women than in men, mostly because women often wear high heels and pointy shoes.  According to the 2012 National Foot Health Assessment conducted by the NPD Group for the Institute for Preventive Foot Health, 8 percent of U.S. women over age 21 (or about 18 million women) have had bunions, and about 4 million men report having the condition.

Causes

There are several causes of bunions:

  • High-heeled, pointy toe, poorly designed or ill-fitting shoes.
  • Heredity:  some inherited foot types—flat or overpronated —are more vulnerable to the formation of bunions.
  • Foot injuries that affect the big toe and little toe joints.
  • Deformities present at birth (congenital issues).
  • Arthritis, including inflammatory or degenerative forms, that cause the protective cartilage that covers the big toe joint to deteriorate.
  • Occupations or leisure activities that put extra stress on the feet or that are associated with pointed shoes (for example, dancers and wearers of western boots).

Prevention and Treatment

The simplest and most effective way to prevent bunions is to choose shoes that provide sufficient width and depth in the toe box so that the toes are not pushed inward. Heels should be as flat as possible, not elevated, to avoid placing additional pressure and stress on the forefoot.

Inserts that provide cushioning and allow the toes to spread in the forefoot, provide arch support to help reduce stress on the feet, and address excessive overpronation can help prevent bunion formation.
Orthotics can help control abnormal foot movement and reduce the probability of bunion formation.

Treatment for bunions includes the following:

  • Wearing appropriate footwear, properly selected and fitted as part of an integrated approach. Properly designed and fitted shoes or boots provide sufficient width in the toe box, which helps ensure minimal compression; also avoid high heels and pointy shoes.
  • Wearing inserts and/or orthotics that provide cushioning and proper arch support. 
  • Wearing padded socks to reduce pressure on the foot.
  • Padding and taping the bunion to reduce and alleviate pain
  • Medications such as acetaminophen and anti-inflammatory drugs, and cortisone injections.

If conservative treatment doesn't provide relief from symptoms, a number of surgical procedures are often performed for bunions.  A bunionectomy typically involves removing the swollen tissue from around the big toe joint, straightening the big toe by removing part of the bone, realignment of the metatarsal bone to reduce angular deformity, or permanently joining the bones of the affected joint.

To ensure that feet are optimally protected at all times, IPFH suggests that you wear only properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional.  Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help protect against injuries to the skin/soft tissue of the foot.

Medical Considerations

Bunions can develop at any time.  Although they don't always cause further complications, they are often painful and are usually permanent unless surgically corrected.  If the bursa over the affected joint becomes inflamed (bursitis), the bunion can be especially painful and can interfere with normal activities.

Always talk with your doctor if you have pain, redness or other indications of problems in any area of your feet that persist for more than a few days.

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