What are bunions?

A bunion, also known as ‘hallux valgus’, is a deformity of the big toe in which the big toe angles excessively towards the second toe and leads to a bony lump on the side of the foot. A large sac of fluid, known as a bursa, may also appear, and this may become inflamed and sore.

What causes them?

Bunions are most often caused by a defective mechanical structure of the foot, which is genetic; these foot types make a person more prone to development of a bunion. Poorly fitting footwear tends to aggravate the problem as tight or narrow footwear can squeeze the forefoot, crowding the toes together and exacerbating the underlying condition, causing pain and deformity of the joint.

Bunions can also be caused by the big toe pushing over on to the second, causing crossover of the toes, which makes it difficult to walk due to pressure on the toes from footwear. Once the big toe leans toward the second toe, the tendons no longer pull the toe in a straight line, so the problem tends to get progressively worse. This condition can also lead to corns and calluses developing.

Bunions can also be caused by age, arthritis or playing sport. 

Who gets them?

Although anyone can get a bunion, they tend to be more common in women, possibly due to some of the more restrictive footwear typically worn (more than 15% of women in the UK suffer from bunions). Women also tend to have looser ligaments. If your parents or grandparents have them, you may also be more prone to developing them.

Are they serious?

Some people have large bunions that are painless but cause difficulties with footwear, while others have relatively small bunions that can be very painful. Although some treatments can ease the pain of bunions, only surgery can correct the defect.

In some cases, pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it toward the third toe and so on. However, just because you have a bunion, does not mean you’ll get a bursa as well.

What are the treatments?

• Exercises 
• Orthoses (special devices inserted into shoes) 
• Shoe alterations or night splints which hold toes straight during sleep (helps to slow the progression of bunions in children) 

These are all conservative measures and although they may help relieve symptoms there is no evidence they can correct the underlying deformity. Your podiatrist will be able to identify any significant deformity and/or defect and may refer you for surgery, which can involve a combination of removing, realigning and pinning of the bone.

Once referred, your podiatric surgeon will evaluate the extent of the deformity. A podiatric surgeon can remove the bunion and realign the toe joint in a common operation known as a first metatarsal osteotomy (‘bunionectomy’). However, there are more than 130 different types of operation that fall under this title, so each individual surgery is different.

The aim of surgery is to address the underlying deformity to prevent recurrence. As with all surgery, there are risks and complications, so it is not usually advised unless your bunions are causing pain or are starting to deform your other toes.

How can I prevent them?

Wearing sensible shoes that fit well is a good preventative measure. If you notice a bump developing where your big toe joins the foot, it may be time to switch your footwear. Try to opt for wider shoes that provide your toes with room to move and keep your heel height to no more than 4cm for maximum comfort. The following also serves as a useful guide:

• Avoid backless, high-heeled shoes. Backless shoes force your toes to claw as you walk, straining the muscles if worn over a long period
• Vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels
• If you want to wear a heel every day, keep heel heights to 4cm or less
• Wearing a shoe with a strap or lace over the instep holds the foot secure and helps stop your foot sliding forward
• Calf stretches to counteract the shortening of the calf can help to keep feet supple

When should I see an NHS podiatrist?

The ECCH MSK Physiotherapy service will now be looking after MSK Podiatry issues. Visit their website or self refer here