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BunionsPublished by Bupa's health information team, August 2008. This factsheet is for people who have bunions, or who would like information about them. When the joint between your big toe and your foot sticks out more than usual, it's often called a bunion. The soft tissues around this affected joint can also become inflamed and painful. This is known as bursitis. If you develop a bunion, you may be able to manage it by wearing appropriate footwear. However, if your bunion is serious and other treatments don't work, you may have to have surgery to try to straighten the joints in your foot.
What are bunions?A bunion develops when your big toe starts to angle towards your second toe. A fluid-filled space called a bursa may also develop under the skin in this area and this can cause pain if it becomes inflamed. This is called bursitis. You may find that your big toe is stiff and its movement is restricted.
SymptomsIf you have a bunion, you may have:
If you also have osteoarthritis, you may have pain in the joint. This will be made worse if you wear poorly fitting footwear. CausesA bunion occurs as a result of a problem with your big toe known as hallux valgus. Hallux means the big toe and valgus means that it's pointing towards the other toes. Hallux valgus occurs when the bone in your foot called the first metatarsal starts to point inwards (towards the centre of your body). This tends to force the joint outwards. As a result, the sac of fluid (bursa) that lies over the joint gets irritated. Inflammation of the bursa (bursitis) adds to the swelling of a bunion. Hallux valgus affects more women than men. This may be because women's ligaments are usually looser than men's and so put them more at risk. If you wear high-heeled shoes, this puts extra strain on the bones and muscles in your foot. In addition, when you wear high-heeled shoes, they push your toes together and force your big toe into a hallux valgus position. There is some evidence that bunions may be inherited. Bunions are sometimes associated with various diseases of the joints including osteoarthritis, but usually there is no obvious underlying cause. DiagnosisYour GP will be able to diagnose a bunion by asking about your symptoms and examining your foot. You may also have an X-ray to assess your bones and joints. TreatmentSelf-helpOne of the most important things you can do is to change your footwear. You should try to wear flat shoes that fit you properly - trainers are good because they protect your feet and are good shock absorbers. You may also wish to put padding over the bunion to give you some cushioning. MedicinesYou can take over-the-counter painkillers such as paracetamol or ibuprofen (eg Nurofen) to help relieve the pain and inflammation of a bunion. Always follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Medicines give temporary relief but they will not reverse the condition or prevent it from getting worse. If you have a bunion as a result of underlying arthritis, your doctor may prescribe specific medicines to treat this. SurgeryIf changing your footwear doesn't help, you may be referred to an orthopaedic surgeon for assessment. There are over 100 different operations that can be carried out to treat hallux valgus. Most of these procedures will aim to straighten out your big toe joint as much as possible. The operation you have will depend on how severe your bunion is and whether or not you have arthritis. The most common type of operation is called a metatarsal osteotomy. The surgeon will break one or more of the bones in your foot and then reset them so they are in line. The part of your big toe joint that is sticking out will also be cut away. The surgeon may also correct the ligaments and tendons within your foot by making them looser or tighter. This procedure may be done under local anaesthetic with sedation or general anaesthetic. Local anaesthetic completely blocks feeling from the area and you will stay awake during the operation. Sedation relieves anxiety and causes temporary relaxation without putting you to sleep. If you have a general anaesthetic, you will be asleep during the operation and feel no pain. Another type of operation that you may have is an exostectomy. In this procedure, also done under either local or general anaesthetic, the surgeon shaves off the part of the bone that is sticking out (ie the bunion). However, he or she won't straighten out the bones in your toe. This operation doesn't really deal with the problem and the bunion is likely to come back eventually. As with all surgery there are risks associated with these procedures. It's likely that you will find the condition is much improved, but you may still have pain and it's possible that in time the bunion will develop again. PreventionYou may be able to prevent hallux valgus by wearing shoes that fit well and comfortably. You can consult a podiatrist or chiropodist for information about ways to prevent bunions and for guidance about suitable footwear. He or she is likely to advise:
Further information
Related topicsSources
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr A Robinson BSc FRCS (Orth) consultant orthopaedic and trauma surgeon at Addenbrooke's Hospital, Cambridge, and Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: August 2008.
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