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A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. The big toe may turn toward the second toe. The tissues around the joint may be swollen and tender.
A bony bump at the base of the little toe is called a bunionette or tailor's bunion. The little toe also bends inward, and the joint swells or enlarges.
You may get bunions if:
All of these may put pressure on the big toe joint. Over time, the constant pressure forces the big toe out of alignment, bending it toward the other toes.
Your bunion may not cause any symptoms. Or you may have pain in your big toe, red or irritated skin over the bunion, and swelling at the base of the big toe. The big toe may point toward the other toes and cause problems in other toes, such as hammer toe. A bunionette can cause similar symptoms at the base of the little toe.
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight.
X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout, rheumatoid arthritis, or joint infection.
Currently, no strong evidence points to the best treatment for bunions. But in most cases, you can treat them at home. This includes taking medicine you can buy without a prescription to relieve toe pain. It also helps to wear shoes that do not hurt your feet. For example, avoid high heels or narrow shoes. You can wear pads to cushion the bunion, and in some cases, you can use custom-made shoe inserts (orthotics).
Avoid activities that put pressure on your big toe and foot. But don't give up exercise because of toe pain. Try activities that don't put a lot of pressure on your foot, such as swimming or bicycling.
Surgery to correct a bunion may be an option if other treatment does not relieve pain. There are different types of surgery for bunions. You and your doctor can decide which one is best for you.
Proper footwear may prevent bunions. Wear roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint.
Medicine will not prevent or cure bunions.
Learning about bunions:
Living with bunions:
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Bunions may be caused by foot mechanics that result in too much pressure on the joint at the base of the big toe (metatarsophalangeal joint). An abnormal foot motion called excessive pronation, having certain foot shapes such as flatfoot, and wearing shoes that squeeze the toes together or shift weight to the toes (such as high-heeled shoes) may all contribute to the pressure. Over time, the constant pressure forces the big toe out of alignment, gradually bending it toward the other toes (displacement).
A bunionette, or tailor's bunion, is one that develops at the base of the little toe. When the long bone that connects to the toe (metatarsal) bends away from the foot, the little toe bends inward and the joint swells or enlarges.
Other factors that can lead to a bunion include:
Your bunion may not cause any symptoms. If you do have symptoms, they may include:
A bunionette causes symptoms that occur at the base of the little toe.
Bunions and their symptoms develop gradually. They are sometimes confused with symptoms of gout, but gout pain comes on suddenly and can be more severe than bunion pain. Gout pain and swelling tend to occur in episodes, while bunion pain is more constant. Unlike a bunion, gout does not usually cause joint deformity. For more information, see the topic Gout.
Bunions on the big toe often begin when an abnormal foot motion called excessive pronation transfers weight to the inner edge of the sole of the foot. This and other factors, such as having flatfoot and wearing tight-fitting shoes, can result in too much pressure on the joint at the base of the big toe, causing the big toe to bend in toward the smaller toes.
A bunion can affect the other toes. As a result of the pressure of the big toe moving toward other toes, you may develop:
A bunion can increase the risk of osteoarthritis in the big toe joint.
Bunions can develop at any time and are found in both children and adults. You are at increased risk for having bunions if you:
Call your doctor if:
Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting may be appropriate if bunion pain is not severe. In this case, try home treatment, such as using ice to relieve pain or wearing comfortable footwear. If there is no improvement after 2 to 3 weeks of home treatment, call your doctor.
Symptoms of a bunion can be evaluated and treated by:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
If you have a bunion, you will notice a bump on your big toe joint. The big toe may turn toward the second toe (displacement), and the tissues surrounding the joint may be swollen and tender.
Bunions are diagnosed through a medical history and physical exam. This may include:
X-rays are often used to find out the degree of bone deformity or to rule out other causes of pain and swelling. If surgery is being considered, X-rays can help your doctor determine what type of surgery will be most helpful in treating the symptoms. X-rays usually are done while you are standing so that the foot is bearing weight. In some cases, magnetic resonance imaging (MRI), computed tomography (CT scan), or a bone scan is also used.
Further tests, such as blood tests or arthrocentesis (removal of fluid from a joint for analysis), are sometimes done if other conditions that can cause joint pain and swelling are suspected, such as gout, rheumatoid arthritis, or joint infection.
If you have a bunion but do not have pain or discomfort, treatment may not be necessary. The goals of treatment for bunions are both to relieve toe pain so that it does not limit daily activities and to prevent the bunion from getting worse.
Most bunions can be treated at home. In some cases, surgery is considered.
Nonsurgical treatment usually is used to decrease pressure on the big toe and relieve pain. Treatment includes:
Physical therapy, splints, or braces have not been proved to successfully treat bunions. But these treatments may be helpful for some people.
If nonsurgical treatment has not relieved toe pain and you aren't able to do normal daily activities, or if you have a severe bunion, you may want to consider surgical treatment. Bunion surgery is done to help restore normal alignment to the toe joint and relieve pain.
There are different types of bunion surgery—the best type of surgery for you depends on how severe your bunion is and how experienced your surgeon is. Look for a surgeon who does many different types of bunion surgery on a regular basis. Each bunion is different, and surgery needs to be tailored to each case.
Proper footwear can help reduce the risk of bunions.
Preventing too much rolling inward of the foot (excessive pronation) during walking or running may help prevent bunions. Excessive foot pronation has been linked to bunion formation. You may be able to prevent excessive pronation by wearing supportive shoes or using arch supports. If you still have excessive pronation, your doctor may suggest that you have custom orthotic shoe inserts made for you.
Home treatment can help relieve toe pain and may prevent a bunion from getting worse. Home treatment includes:
To relieve toe pain:
For children with bunions, using orthotic insoles to correct a walk where the foot rolls inward (excessive pronation) is questionable. Some studies show that bunions in children may not be related to pronation.1
Children who have bunions should see a doctor if foot pain is limiting their activity. In some cases, the doctor may recommend surgery.
Medicine will not prevent or cure bunions. But it may relieve pain and inflammation and allow you to do your normal daily activities.
If your toe pain is not severe, you can try nonprescription medicine first, such as:
Bunion surgery generally involves making an incision in the top or side of the big toe joint area and removing or realigning soft tissue and bone. The goals of surgery for bunions are to:
You may have to consider surgery if your bunion results in persistent, severe pain that limits your daily activities or if you have a severe foot deformity.
Surgery is not recommended if you:
Athletes, children, and people with certain health problems are generally advised to take a conservative, nonsurgical approach when considering bunion treatment.
Joint replacement surgery is not often done to repair a bunion. If your doctor recommends joint replacement, get a second opinion.
Some issues to consider when deciding about bunion surgery:
Treatment options for bunions include arch supports, custom-made orthotics, and custom-made shoes. All of these temporarily change the way the bones, muscles, and ligaments of the foot work together. They will not cure the bunion, but they may help relieve some structural problems that are contributing to it by:
Arch supports are available without a prescription. Orthotics and custom-made shoes are available with a prescription and are professionally fitted to your foot.
|American Academy of Orthopaedic Surgeons (AAOS)|
|6300 North River Road|
|Rosemont, IL 60018-4262|
The American Academy of Orthopaedic Surgeons (AAOS) provides information and education to raise the public's awareness of musculoskeletal conditions, with an emphasis on preventive measures. The AAOS website contains information on orthopedic conditions and treatments, injury prevention, and wellness and exercise.
|American College of Foot and Ankle Surgeons (ACFAS)|
|8725 West Higgins Road|
|Chicago, IL 60631-2724|
The American College of Foot and Ankle Surgeons provides information on surgery and shoe selection as well as the care and treatment of heel, toe, ankle, nerve, tendon, nail, and skin conditions. You can also look up and learn about sports injuries, diabetic foot problems, arthritis, and resources in your local area.
|American Orthopaedic Foot and Ankle Society|
|6300 North River Road|
|Rosemont, IL 60018|
The American Orthopaedic Foot and Ankle Society (AOFAS) provides information on a variety of topics, including foot care for adults, children, and people who have diabetes; proper shoe fit; and how to select children's shoes and sports shoes. Some information is available in several languages besides English.
|American Podiatric Medical Association|
|9312 Old Georgetown Road|
|Bethesda, MD 20814-1621|
The American Podiatric Medical Association (APMA) provides information about foot and ankle injuries, sports-related foot concerns, surgical and nonsurgical treatment of foot problems, special medical issues such as diabetes, and resources in your local area. Some information is available in Spanish.
- Ferrari J (2009). Bunions, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Other Works Consulted
- American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Hallux valgus. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 819–821. Rosemont, IL: American Academy of Orthopaedic Surgeons.
- Perera AM, et al. (2011). The pathogenesis of hallux valgus. Journal of Bone and Joint Surgery, American Version, 93(17): 1650–1661.
- Vanore JV, et al. (2003). Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1. Hallux valgus. Journal of Foot and Ankle Surgery, 42:(3) 112–123.
|Primary Medical Reviewer||William H. Blahd, Jr., MD, FACEP - Emergency Medicine|
|Specialist Medical Reviewer||Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery|
|Last Revised||February 24, 2012|
Last Revised: February 24, 2012
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