Bunion (Hallux Valgus)

A bony bump (protrusion) on the inside of the foot, at the base of the first toe, is called a bunion (hallux valgus). A bunion causes the first toe to angle toward the other toes.

SYMPTOMS

  • A bony bump on the inside of the foot, causing an outward turning of the first toe. It may also overlap the second toe.

  • Thickening of the skin (callus) over the bony bump.

  • Fluid buildup under the callus. Fluid may become red, tender, and swollen (inflamed) with constant irritation or pressure.

  • Foot pain and stiffness.

CAUSES

Many causes exist, including:

  • Inherited from your family (genetics).

  • Injury (trauma) forcing the first toe into a position in which it overlaps other toes.

  • Bunions are also associated with wearing shoes that have a narrow toe box (pointy shoes).

RISK INCREASES WITH:

  • Family history of foot abnormalities, especially bunions.

  • Arthritis.

  • Narrow shoes, especially high heels.

PREVENTION

  • Wear shoes with a wide toe box.

  • Avoid shoes with high heels.

  • Wear a small pad between the big toe and second toe.

  • Maintain proper conditioning:

  • Foot and ankle flexibility.

  • Muscle strength and endurance.

PROGNOSIS

With proper treatment, bunions can typically be cured. Occasionally, surgery is required.

RELATED COMPLICATIONS

  • Infection of the bunion.

  • Arthritis of the first toe.

  • Risks of surgery, including infection, bleeding, injury to nerves (numb toe), recurrent bunion, overcorrection (toe points inward), arthritis of the big toe, big toe pointing upward, and bone not healing.

TREATMENT

Treatment first consists of stopping the activities that aggravate the pain, taking pain medicines, and icing to reduce inflammation and pain. Wear shoes with a wide toe box. Shoes can be modified by a shoe repair person to relieve pressure on the bunion, especially if you cannot find shoes with a wide enough toe box. You may also place a pad with the center cut out in your shoe, to reduce pressure on the bunion. Sometimes, an arch support (orthotic) may reduce pressure on the bunion and alleviate the symptoms. Stretching and strengthening exercises for the muscles of the foot may be useful. You may choose to wear a brace or pad at night to hold the big toe away from the second toe. If non-surgical treatments are not successful, surgery may be needed. Surgery involves removing the overgrown tissue and correcting the position of the first toe, by realigning the bones. Bunion surgery is typically performed on an outpatient basis, meaning you can go home the same day as surgery. The surgery may involve cutting the mid portion of the bone of the first toe, or just cutting and repairing (reconstructing) the ligaments and soft tissues around the first toe.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • After surgery, you develop fever, increasing pain, redness, swelling, drainage of fluids, bleeding, or increasing warmth around the surgical area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)