Footcare Scotland - The Foot & Ankle Experts

What is a bunion?

A bunion, or Hallux Valgus, is a common deformity of the big toe.  The big toe excessively tilts towards the 2nd toe and develops a bony prominence on the side of the foot.  The prevalence of bunions is greater in females and older people.

What causes bunions?

There is no one cause of bunions, it is thought the development of a bunion is multi-factorial.  Bunions do tend to run in families and are more common in people with flexible joints and flat feet.  Contrary to popular belief, bunions are not generally caused by footwear.

What are the symptoms?

With the deformity making the foot wider, a common complication of bunions is irritation from footwear.  This can occur in many forms but the most common sites for footwear irritation are on the bony prominence of the bunion, or on top of the 2nd toe.  Sometimes, due to irritation from footwear, a bursitis (inflamed fluid filled sac) can develop over the prominence.  With the big toe invading the space of the 2nd toe, it is common for the 2nd toe to ride up and rub on the inside of the shoe.

Secondary problems

Corns and callus (hard skin) are also common secondary problems with bunions.  These calluses and corns can form between the toes, on the bony prominence, or on the sole of the foot.

With the 2nd toe riding up, another common problem secondary to a bunion is pain affecting the ball of the foot.  This is sometimes called transfer metatarsalgia.  Due to the faulty mechanics of the foot, overloading of the 2nd toe joint occurs.  This joint can become painful and inflamed, or the joint itself can become unstable, leading to pain and further deformity.

What are the treatment options?

The first line of treatment should be finding a comfortable shoe.  Depending on the severity of the deformity, you are likely to need a shoe with more width and depth in the toe box.  This will reduce the irritation from footwear and limit your symptoms.  Try and avoid wearing high heels or shoes with a tight or shallow toe box.

Simple pads can be an effective, short term, relief from symptoms.  Try using felt or gel pads to reduce irritation from footwear and relieve pressure points.

We often use orthoses (special, medical insoles) to offload the painful bunion and these  are very successful in treating pain under the ball of the foot.  They reduce the pressure on the painful joints and can be worn inside suitable footwear to very good effect.

Surgical options

Surgery is indicated, if conservative measures have failed, or you cannot find a comfortable shoe.  There are many different operations for bunions, depending on the severity of the deformity.   Our orthopaedic surgeon, Mr. Clayton, can advise you of the best operation for you.  As with all operations, there are risks and there is a significant recovery time after the surgery.

If you have a painful bunion, or problems secondary to bunions, why not book an appointment to discuss how we can help.


Article by Alastair Dall