Bunions: Symptoms, Causes, Diagnosis, and Treatment

A bunion is a bony protrusion that typically juts out from the side of the big toe. It is associated with a condition, known as hallux valgus, where the big toe points inward toward the second toe. Less commonly, a bunion may form next to the small toe, and this is referred to as a "bunionette" or "tailor's bunion." Several factors—some of which can be controlled, some of which can't—make a person more vulnerable to developing bunions.

A healthcare provider can usually diagnose a bunion simply by looking at your foot. Most of the time bunions are treated conservatively with self-care strategies, but surgery may be indicated in some cases.

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If bunion symptoms do occur, they usually develop over time, well after the bump has formed. Symptoms may include one or more of the following:

While the precise cause behind bunion formation has not been completely sorted out, experts believe that certain foot types make a person more prone to developing bunions, and these foot types tend to run in families.

More specifically, experts suspect that a combination of a certain foot type, along with years of abnormal pressure over the big toe joint (called the first metatarsophalangeal joint), is what commonly leads to bunion formation. In particular, wearing shoes that crowd the toes together is a common culprit. This is, in part, why women tend to develop bunions more than men; many women's shoes have narrow toe boxes. High heels can make matters worse by forcing the toes even deeper into the narrowed tip.

Besides narrow footwear and an inherited foot type, other factors that may contribute to bunion formation include:

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The diagnosis of a bunion can be made by physical exam alone, as this bony deformity is visible to the naked eye. That said, to fully access the bunion and big toe joint, your healthcare provider may order an X-ray.

Treatment of a bunion is only required if it is causing symptoms. While there are numerous non-surgical treatment options available, if bunion symptoms are severe or persistent, then surgery to correct the misalignment may be considered.

When dealing with acute bunion pain, these self-care strategies may give you some relief:

To ease the pain of a bunion, your healthcare provider may recommend taking an over-the-counter anti-inflammatory medication, like Advil (ibuprofen).

Less commonly, your healthcare provider may inject a steroid (cortisone) into the bursa (the sac surrounding the big toe joint) to relieve inflammation.

If you have a painful bunion, you can relieve some of the pain by either padding the bunion from the outside or forcing the toes into a more natural position.

Bunion pads are readily available at most drugstores and are made either of moleskin, neoprene, foam, silicone, or a gel-filled plastic. They lessen the pressure placed on the bunion while wearing shoes and tend to work best when wearing shoes with a wide toe box. While most bunion pads are applied with a removable adhesive strip, others are woven into the fabric of removal booties.

Toe spacers, as per their name, are placed between your toes. Most are made of contoured foam or plastic. While some only open the space between the big toes, newer, glove-like models are constructed of neoprene and separate all five toes.

Among the variety of bunion relief appliances, there are night splints that can gradually correct the toe alignment and even slip-on inserts that combine a bunion pad with individual toe separators.

Even if the shoes you wear have low heels and a square foot box, they may not fit properly. Many foot problems arise simply because of choosing fashion over comfort and support.

While you may think you know your correct size, manufacturer sizes can vary enormously, leaving you swimming in some shoes and barely able to put on others. Moreover, your shoe size can change as you age since the vertical pressure placed on your feet can, over time, cause the bones and cartilage to flatten and spread.

To prevent or correct a foot problem, get your feet correctly measured every five years or so.

A specialty running shoe store is a great place to get your feet measured, as these retailers are likely to conduct a comprehensive foot evaluation. This not only involves the sizing your foot but an assessment of your foot alignment and arch.

The evaluation can give you insight about what type of shoe is best for you, including whether you need custom orthotics or arch supports. The better your shoes fit, the less likely your toes will slip forward and become compressed.

If searching for the right shoe to treat bunion pain, always look for the following features:

Some podiatrists refer their patients to a physical therapist who specializes in treating foot conditions. To ease inflammation and bunion pain, your physical therapist may use ultrasound therapy.

If your bunion pain is severe or persistent and/or diminishing your overall daily functioning/quality of life, it's sensible to discuss surgery with your healthcare provider. The goals of bunion-reducing surgery are to alleviate bunion pain and deformity. Surgery may be done to help realign the toe joint and restore function (hallux valgus surgery).

Depending on various factors like your age, activity level, and the severity of your bunion, your surgeon will choose one of many surgical procedures, including osteotomy (bone realignment), arthrodesis (joint fusion), resectional arthroplasty (removal of the damaged joint), or exostectomy (removal of the bunion bump only). Exostectomy is rarely performed alone; since it does not realign the big toe joint, the bunion often recurs.

If you are uncertain as to whether surgery is right for you, consider asking your foot and ankle surgeon these questions:

These responses, along with the cost of the recommended procedure, can help you make an informed choice.

A bunion, albeit common, can be a frustrating foot condition to deal with. However, with the right self-care strategies and some diligence on your part, most people can manage their bunion(s) well.

That said, if you are not obtaining relief with simple measures or your bunions are affecting your mobility or daily quality of life, be sure to talk with your healthcare provider about next steps. Surgery may be a sensible option for you at this point.

Factors that can cause or contribute to bunions include:

Yes. Bunion pain can include elevating bare feet to relieve pressure and inflammation, applying an ice pack wrapped in a towel for 10 to 15 minute intervals, soaking feet in cool water to reduce swelling, and foot stretches.

Surgery can be done to correct the joint's misalignment, but it is usually only recommended if the bunion disrupts daily life.

Not all bunions can be prevented, and they may form due to genetic factors. However, the following options may help reduce the likelihood of developing a bunion.

Yes, there are exercises that can relieve bunion pain and strengthen foot muscles. It is thought that weak muscles play a role in bunion pain and movement problems. A healthcare provider may prescribe specific exercises to improve foot muscle strength.

Shi GG, Humayun A, Whalen JL, Kitaoka HB. Management of Bunionette Deformity. J Am Acad Orthop Surg. 2018;26(19):e396-e404.

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). Bunions: Overview. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513134/

Ferrari J. Bunions. BMJ Clin Evid. 2009;2009:1112.

Ellington JK. Hammertoes and clawtoes: proximal interphalangeal joint correction. Foot Ankle Clin. 2011;16(4):547-58.

Al Aboud AM, Badri T. Corns. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470374/

Tamer P, Simpson S. Evolutionarily medicine Why do humans get bunions? [published correction appears in Evol Med Public Health. 2017 May 09;2017(1):81]. Evol Med Public Health. 2017;2017(1):48–49. doi:10.1093/emph/eox001

Chou LB. Disorders of the first metatarsophalangeal joint: diagnosis of great-toe pain. Phys Sportsmed. 2000;28(7):32-45.

Kitson K. Bunions: their origin and treatment. J Perioper Pract. 2007;17(7):308-10, 315-6.

Kalen V, Brecher A. Relationship between adolescent bunions and flatfeet. Foot Ankle. 1988;8(6):331-6.

Shirley ED, Demaio M, Bodurtha J. Ehlers-danlos syndrome in orthopaedics: etiology, diagnosis, and treatment implications. Sports Health. 2012;4(5):394–403. doi:10.1177/1941738112452385

Nork SE, Coughlin RR. How to examine a foot and what to do with a bunion. Prim Care. 1996;23(2):281-97.

Ferrari J, Higgins JP, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev. 2004;(1):CD000964.

Hurn SE, Vicenzino BT, Smith MD. Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists. J Foot Ankle Res. 2016;9:16. doi:10.1186/s13047-016-0146-5

Grice J, Marsland D, Smith G, Calder J. Efficacy of Foot and Ankle Corticosteroid Injections. Foot Ankle Int. 2017;38(1):8-13.

Tehraninasr A, Saeedi H, Forogh B, Bahramizadeh M, Keyhani MR. Effects of insole with toe-separator and night splint on patients with painful hallux valgus: a comparative study. Prosthet Orthot Int. 2008;32(1):79-83.

Branthwaite H, Chockalingam N, Greenhalgh A. The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females. J Foot Ankle Res. 2013;6:28. doi:10.1186/1757-1146-6-28

Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679–1685. doi:10.2337/dc08-9021

Menz HB. Foot orthoses: how much customisation is necessary?. J Foot Ankle Res. 2009;2:23. doi:10.1186/1757-1146-2-23

Mortka K, Lisiński P. Hallux valgus-a case for a physiotherapist or only for a surgeon? Literature review. J Phys Ther Sci. 2015;27(10):3303–3307. doi:10.1589/jpts.27.3303

Meyr AJ, Singh S, Chen O, Ali S. A pictorial review of reconstructive foot and ankle surgery: hallux abductovalgus. J Radiol Case Rep. 2015;9(6):29–43. doi:10.3941/jrcr.v9i6.2142

Bunion: Strengthening foot muscles to reduce pain and improve mobility. J Orthop Sports Phys Ther. 2016;46(7):606. doi:10.2519/jospt.2016.0504

American Podiatric Medical Association. (2019). Bunions. https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=979

Dini M. Podiatric Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. eds. Current Medical Diagnosis & Treatment 2019 New York, NY: McGraw-Hill; http://accessmedicine.mhmedical.com/content.aspx?bookid=2449&sectionid=194443900.

Ferrari J (2017). Hallux valgus deformity (bunion). Eiff P, Asplund CA, eds. UpToDate. Waltham, MA: UpToDate Inc.

Hern, S.; Vicenzino, B.; and Smith, M. Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists. J Foot Ankle Res. 2016;9:16. DOI: 10.1186/s13047-016-0146-5.

MacDonald, A.; Houck, J.; and Baumhauer, J. The Road to Recovery for Bunion Surgery. Foot Ankle Orthoped. 2017. DOI: 10.1177/2473011417S000275.

By Catherine Moyer, DPMCatherine Moyer, DPM, is a podiatrist experienced in the diagnosis, treatment, and prevention of disorders of the foot and ankle.