Bunions

• Alternative Names

  Hallux valgus

• Causes, incidence, and risk factors

  Bunions occur more commonly in women and can sometimes run in families. People born with abnormal bones in their feet are more likely to form a bunion. Wearing narrow-toed, high-heeled shoes may lead to the development of a bunion. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe.

  

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  Bunion
• Symptoms
  • Red, calloused skin along the inside edge of the big toe
  • A bony bump at this site
  • Pain over the joint, aggravated by pressure from shoes
  • Big toe turned toward the other toes
• Signs and tests

  A doctor can usually diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot and, in some cases, arthritis.

• Treatment

  When a bunion first begins to develop, take good care of your feet and wear wide-toed shoes. This can often solve the problem and prevent the need for any further treatment. It may help to wear felt or foam pads on the foot to protect the bunion, or devices called spacers to separate the first and second toes at night. These are available at drugstores. You can also try cutting a hole in a pair of old, comfortable shoes to wear around the house.

  If the bunion gets worse -- resulting in severe deformity or pain -- surgery to realign the toe and remove the bony bump (bunionectomy) can be effective. There are over 100 different surgical techniques that have been described to treat this condition.

• Expectations (prognosis)

  The outlook depends on your age and activities, and the severity of the bunion. Teenagers may have more trouble treating a bunion than adults. Many adults do well by caring for the bunion when it first starts to develop, and wearing different shoes. Surgery reduces the pain in many, but not all, people with bunions.

• Complications
  • Chronic foot pain
  • Foot deformity
  • Stiff foot
  • Hallux varus (occurs with surgical over-correction, where the toe points away from the second toe)
• Calling your health care provider

  Call for an appointment with your doctor if the bunion:

  • Continues to cause pain even after self care, such as wearing wide-toed shoes
  • Prevents you from doing your usual activities
  • Has any signs of infection (like redness or swelling), especially if you have diabetes
• Prevention

  Avoid compressing the toes of your foot with narrow, poor-fitting shoes.

• References

  Vanore JV. Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1: Hallux valgus. J Foot Ankle Surg. 2003; 42(3): 112-123.

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

  Wexler D, Grosser DM, Kile TA. Bunion and bunionette. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier:2008;chap 76.

Review Date: 3/4/2009

Reviewed By: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.