The cause of a bunion may be hereditary but it is more often acquired from prolonged pressure on the foot caused from narrow-toed, high-heeled shoes that compress the big toe and push it toward the second toe. The condition may become painful as extra bone and a fluid filled bursa grow where the base of the great toe meets the foot and the overlying skin. These changes lead to inflammation and pain. This condition occurs more frequently in women and is much less common in societies where shoes are not worn.

• reddened skin over the base of the great toe meets the foot
• pain over the joint where the great toe joins the foot (MTP joint)
  • aggravated by pressure from shoes
• great toe turns toward the other toes

Physical examination of the foot reveals a great toe angled towards the second toe and often red, calloused skin on the inside of the foot where the base of the first toe joins the rest of the foot. There is often a bony prominence in this same area.

A foot X-ray will demonstrate an abnormal angle between the first toe and the foot and in some cases arthritis.

In the early stages, good foot care and wide toed shoes may prevent the need for further treatment of the bunion. Felt or foam pads on the foot to protect the bunion, or devices to separate the first and second toes at night may reposition the joint.

If the bunion progresses resulting in severe deformity or pain, surgery to realign the toe and remove the bony prominence (bunionectomy) has been proven to be effective. There are over 100 different surgical techniques that have been described for hallux valgus.

Prognosis depends on age, activity and severity. Adolescents with hallux valgus do less well than do adults. Many adults do well with conservative treatment (callous care and shoe wear modification) and surgery will improve pain in approximately 86% of patients.

• chronic foot pain
• foot deformity
• stiff foot
• hallux varus (occurs with surgical over-correction and the toe points away from the second toe)

Call for an appointment with the health care provider if bunions continue to cause pain after good foot care and wide toed shoes.

Avoid compressing the toes of the foot with narrow, poor-fitting shoes.