Bunions

What are bunions?

A bunion is inflammation of the soft tissues around the outer edge of the big toe at the joint where it is attached to the foot. The medical term for this type of inflammation is 'bursitis' and refers to the bursa or sac near the joint. Bunions are associated with various diseases of the joints including osteoarthritis and rheumatoid arthritis but usually there is no obvious underlying illness.

What causes bunions and who is at risk?

A bunion occurs as a result of a deformity in the big toe known as 'hallux valgus'. This is when the bone inside the foot which joins the big toe becomes displaced outwards and the joint rubs against the inside of footwear.

Hallux valgus, and bunions, occur almost exclusively in women. This may be because unknown genetic and anatomical factors predispose women to developing the condition, but is probably because women tend to wear ill-fitting shoes. High-heeled shoes, for example, put abnormal strains on the bones and muscles of the foot, and shoes which are tight around the foot force the big toe into a hallux valgus position. Once in this position, the big toe joint will rub against the inside of the tight, ill-fitting shoe causing inflammation in the bursal sac: bursitis or bunion.

Hallux valgus is much more common with increasing age, although it may occur in the young, but as hallux valgus increases with age so does the development of bunions.

Hallux valgus occurs commonly in osteoarthritis which is due to wear and tear of the joints. As a result of disease in the joint, the big toe can more easily become hallux valgus.

What are the common symptoms and complications of bunions?

Pain

Redness around the big toe joint

Swelling over the big toe joint

Difficulty in walking

If osteoarthritis is the underlying cause, there may also be pain in the joint, made worse by non-supportive footwear



How do doctors recognise bunions?

The diagnosis is made simply by the history of the complaint and a clinical examination of the toe. An X-ray may be taken to confirm this.

What is the treatment for bunions?

Hallux valgus is often preventable and treatable by wearing well-fitting footwear.

Self-care action plan

Wear well-fitting shoes

Avoid high-heeled or tight shoes

Get advice from a podiatrist on footwear

Padding over the bunion may help



Medicines

Painkillers such as paracetamol or the non-steroidal anti-inflammatory drug, ibuprofen, will often help relieve the pain and inflammation. However, they will not reverse the progression of the condition and should only be considered as temporary relief while adequate footwear is tried.

Surgery

If a change in footwear does not help, you may referred to an orthopaedic surgeon. The most common operation performed for bunions is called an excision arthroplasty. The surgeon will cut way the part of the big toe joint that is sticking out and causing the trouble.

What is the outcome of having bunions?

Bunions are so easily prevented and treated by wearing appropriate footwear that, in the absence of an underlying condition such as osteoarthritis, they should rarely require surgery. If a hallux valgus deformity does require surgery however, the operation is very successful.