Bunions: Picture, symptoms, diagnosis, treatment and prevention

Picture of a bunion

A bunion is a bony lump that forms at the base of the big toe where it attaches to the foot. Often, the big toe deviates towards the other toes. When this occurs the base of the big toe pushes outwards on the first metatarsal bone - which is the bone directly behind the big toe - forming a bunion. If this happens on the little toe and fifth metatarsal, it is called a bunionette.

Because a bunion occurs at a joint, where the toe bends during normal walking, your entire body weight rests on the bunion at each step. Bunions can be extremely painful. They are also vulnerable to excess pressure and friction from shoes and can lead to the development of calluses.

How do I know if I have bunions?

Although bunions are usually obvious from the pain and unusual shape of the toe, further investigation is often advisable. Your doctor will usually send you for X-rays to determine the extent of the deformity. Blood tests may be advised to see if some type of arthritis could be causing the pain. Based on this evaluation, your doctor can determine whether you need orthopaedic shoes, medication, surgery or other treatment.

What are the symptoms of bunions?

Look for an angular, bony bump on the side of the foot at the base of the big toe. Sometimes hardened skin or a callus covers this bump.

There's often swelling, redness, unusual tenderness, or pain at the base of the big toe and in the ball of the foot. Eventually, the area becomes shiny and warm to the touch.

Seek medical advice if:

If you have persistent pain when walking normally in otherwise comfortable, flat-soled shoes, you may be developing a bunion, bursitis, or a bone spur in your foot.

What are the treatments for bunions?

Your doctor may recommend a prescription or over-the-counter pain reliever, as well as medication to relieve the swelling and inflammation. A heat pad or warm foot bath may also help relieve the immediate pain and discomfort. A few people may obtain relief with ice packs.

If your bunion isn't persistently painful and you take action early on, changing to well-made, well-fitting shoes may be all the treatment you need. Your doctor may advise use of orthoses (devices that are used to improve and realign the bones of your foot), including bunion pads, splints, or other shoe inserts, provided they don't exert pressure elsewhere on the foot and aggravate other foot problems.

In some cases, an orthotist (someone trained to provide splints, braces and special footwear to aid movement, correct deformity and relieve discomfort) can prescribe shoes with specially designed insoles and uppers that take the pressure off affected joints and help the foot regain its proper shape.

Surgery may be recommended for some bunions, but only when symptoms are severe enough to warrant such intervention.

Surgery for a bunion, called a bunionectomy, is done in hospital usually under general anaesthesia. The surgeon can often realign the bone behind the big toe by cutting the ligaments at the joint. For a severe bunion, you may need to have the bone cut in a technique called an osteotomy. Wires or screws may be inserted to keep the bones in line, and excess bone may be shaved off or removed. Potential complications of surgery include recurrence of the bunion, inadequate correction, overcorrection (the toe now points inwards), continued pain, and limited movement of the big toe.