Bunions

What is a bunion?

A bunion is the name given to a bump on the inside of your big toe joint.

Some people get this when they are very young in their teenage years and this is due to having floppy joints. Most bunions occur later in life and it often gets progressively worse with time. Bunions can range from mild to moderate to severe.

What causes bunions?

There is some research to show that wearing shoes, especially high-heeled pointy shoes, makes it worse but it can happen even without ever wearing shoes. It runs in families and is more common in women.

Behind each toe is a bone called a “metatarsal”, a bunion happens when your big toe metatarsal (1st metatarsal) moves to point inwards. When this happens it is no longer directly behind the big toe and the toe tips off the end, and starts pointing towards the outside of your foot.

What problems does it cause?

A bunion can be painful and make it difficult to fit the foot into shoes. The amount of pain coming from a bunion does not always match with how bent the toe is. Some mild bunions are very painful and some severe bunions don’t hurt.

As the big toe tips off the end of the metatarsal it will eventually start to rub on the second toe. If left long enough it will then go underneath or on top of the second toe.

A bunion also affects the way the foot works. In a normal foot half the body weight goes through the 1st metatarsal, but in a bunion more weight goes through the other metatarsals and this can cause pain under the smaller toes.

Non-surgical treatment:

Wearing flat shoes with enough room for your toes is important. Splints will not treat a bunion in the long run.

Surgery

Surgery depends on how severe your bunion is and if you have arthritis as well as a bunion. The most common surgery involves cutting the 1st metatarsal bone and changing its position back behind the toe so that the toe sits straight. Less commonly one of the joints in your foot may need “fusing” together permanently to correct the foot. Other toes can be straightened at the same time.

After surgery

It is important that you follow your doctor’s advice, below is for reference only. 

After surgery you should be comfortable and nearly all patients go home on the same day. You will have a bandage on your foot and a special stiff soled shoe to protect the foot while it heals.

For the first 2 weeks you will need to keep your foot elevated above your heart at home to keep the swelling down. This reduces pain, reduces the risk of infection and allows the wound to heal.

You will be allowed to walk on the foot from day 1.

At 2 weeks your bandages will come off and the stitches will be removed.

After 6 weeks the stiff soled shoe will come off and you can go back into normal shoes. The toe may be stiff at first but with stretching and time this will improve.

It is crucial you don’t smoke (including e-cigarettes) or take anti-inflammatories for 6 weeks after the surgery.

What is a bunion?

This website is designed and run by Mr Edward Gee, a Consultant Orthopaedic Surgeon specialising in Foot and Ankle Surgery, as an educational resource for Patients and Professionals.

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Foot and Ankle Expert FAQs

    The medical term for a bunion is ‘hallux valgus’ and this is a condition where your big toe starts to angle outwards and the bone behind it (the first metatarsal) protrudes out of the inside edge of the foot. This is incredibly common and may be related to your genes or lifestyle factors such as your shoes or activities. This is a progressive deformity and generally gets worse over time, it can eventually lead to arthritis of the big toe joint.

    Your bunion may be painful, making it difficult to walk and you may put more weight onto the outside of your foot, causing secondary pain in the balls (metatarsal heads) of the lesser toes. Your big toe may eventually overlap or underlap the second toe, pushing it up or down against your shoes. The bump on the inner edge of your foot may make it difficult to wear certain shoes and may rub on the shoes or even wear through the shoe material.

    As a foot and ankle specialist I will be able to correctly identify if you have a bunion and if your symptoms are directly related to your bunion. Examination of your foot will help me to identify the type of bunion you have, and which treatment is likely to help. X-rays will help me to see how severe it is and to plan the best surgical option specifically for you.

    If you have a mild bunion and very little pain, you may simply need wider shoes. If your bunion is more painful or more severe than a surgical procedure may be appropriate to reposition the bones and straighten the toes. This usually involves an open procedure, but for some cases a keyhole or “minimally invasive” procedure is available. After surgery you will be able to put your full weight through the foot straight away, but you will need to rest and elevate the foot for the first 2 weeks to allow your wound to heal. By 6 weeks your bones will be healed and you will be back in normal shoes. It usually takes roughly 3 months to get back to full activities.

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