Bunions

What Is a Bunion?

A bunion (hallux valgus) is a bony bump that forms at the base of the big toe where it meets the foot. As the deformity progresses, the big toe gradually angles toward the second toe, and the joint at the base of the big toe protrudes outward. This can cause significant pain, swelling, and difficulty finding comfortable shoes.

Bunions are far more common in women than men, largely due to the influence of footwear choices over time.

Causes

Bunions are caused by three contributing factors:

1. Heredity — an inherited foot type or structural abnormality that predisposes the joint to this deformity
2. Footwear — tight, narrow, or high-heeled shoes that force the large toe inward and place sustained pressure on the joint
3. Poor foot mechanics — abnormal pronation or muscle imbalance that allows the bony structures to drift out of alignment over time

Hereditary factors alone cannot be directly treated, but addressing footwear and foot mechanics can significantly slow or stop progression.

Symptoms

• A visible bump on the outside of the base of the big toe
• Swelling, redness, or soreness around the big toe joint
• Restricted movement of the big toe
• Persistent or intermittent pain at the joint, especially with activity
• Corns or callouses where the first and second toes overlap
• Difficulty finding shoes that fit comfortably

Treatment

Non-Surgical Options

The first line of treatment for bunions is always conservative. Many patients are able to manage their bunions effectively without ever requiring surgery:

• Shoe modification — switching to shoes with a wide, deep toe box that accommodates the joint without pressure. Shoes should be fitted at the end of the day, when feet are at their largest.
• Custom orthotics — if the bunion is being driven by poor foot mechanics, orthotics can correct the underlying biomechanical fault and slow or halt progression
• Physical therapy — muscle strengthening and stretching exercises to improve joint stability
• Splints — morning and evening splinting can reduce stress on the joint and slow deformity progression
• Padding and taping — temporary relief of friction and pressure on the joint
• Anti-inflammatory medication or ice — for managing acute pain and swelling

Surgical Treatment

When conservative measures no longer provide adequate relief, surgery is an effective option. The goals of bunion surgery are to:

• Reduce or eliminate pain at the joint
• Remove the bony prominence
• Realign the big toe
• Restore normal function

Surgical techniques vary depending on the severity of the deformity and may include soft tissue realignment, bone cutting (osteotomy), and fixation with pins or screws. In more complex cases, a cast and crutches may be necessary during recovery.

Dr. Ross will walk you through every surgical option in plain language, explain what recovery looks like, and help you make the decision that best fits your life. Please call us with any questions about bunion surgery or its alternatives.