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Bunions

Updated: July 2021

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Overview:

Bunions are the bump you develop on the medial (arch side) of your foot and your big toe leaning toward your second toe. They may cause pain when you walk, make it difficult to wear certain shoes and increase your risk of falling over. The medical term for a bunion is hallux valgus.

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bunions (hallux valgus)

Signs or symptoms you may experience:

While the bunion may be painless, the changes it creates in your foot may cause pain or problems elsewhere in your foot.

  • Difficulty fitting footwear due to increased forefoot width or depth

  • Forefoot or toe pain when wearing certain shoes

  • Corns or callus on the medial side of the forefoot, under the ball of your foot or between your toes

  • Pain under your forefoot

  • Claw or hammer toes

  • Ingrown toenails from the changed position and pressure on the toes

  • Having a fall for people over 65 years of age

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Types of bunions

Bunions can occur in children, adults and older adults but are most common in older adults (1 in 3 people over 65 years of age). They may occur in one foot or both feet but are more likely to occur in both feet the longer you have a bunion. They may progress to a larger bunion slow or fast and may be painless or painful.  We often use a scale (called the Manchester scale) to describe appearance and progression of your bunion (see picture below).

  • Stage 1 (Mild): small bump with the big toe touching the 2nd toe

  • Stage 2 (Moderate): bigger bump with the big toe beginning to push the 2nd toe further across

  • Stage 3 (Severe): large bump and wide forefoot with big toe pushing lesser toes out of the way

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manchester scale

What causes a bunion?

There are many proposed causes for bunions but only some have research to show a relationship

  • Genetics: if your parents or siblings have a bunion, you are twice as likely to develop one.

  • Footwear: women wearing narrow footwear on their forefoot between the ages of 20 and 40 are twice as likely to develop a bunion as women who wore wider fitting footwear

  • Flat feet: men with flat feet are twice as likely to develop a bunion compared to men without flat feet

  • Weak foot muscles: one of the muscles that bends the big toe down and another muscle that pulls the big toe away from the second toe are usually weaker in people with a bunion but we don't know if the muscle weakness helped cause the bunion or if the bunion caused the muscle weakness

  • Joint trauma or rheumatoid arthritis may also be associated with bunions by reducing the stability of the big toe joint

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Treatment options:

The aim of treatment is to reduce your symptoms and address any related issues.  Usually a combination of treatments will be required. While the aim of treatment is to resolve symptoms, some individuals may have no benefit or increased symptoms from some treatments. Cease these treatments and contact Inform Podiatry. 

  • Footwear advice

  • Orthoses (shoe inserts) to improve foot function 

  • Footwear modification (changing laces or insert thickness etc)

  • Bunion padding (silicon bunion pads)

  • Muscle strengthening/retraining

  • Foot taping to improve foot function

  • Muscle/joint stretching 

  • Modifying exercise or activities

  • Medication such as gel anti-inflammatories

  • Advice regarding when a surgical opinion should be considered and which Foot and Ankle Surgeon to see

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Information sources:

  • Nix, Sheree, Michelle Smith, and Bill Vicenzino. "Prevalence of hallux valgus in the general population: a systematic review and meta-analysis." Journal of foot and ankle research 3.1 (2010): 1-9.

  • Menz, Hylton B., and Shannon E. Munteanu. "Radiographic validation of the Manchester scale for the classification of hallux valgus deformity." Rheumatology 44.8 (2005): 1061-1066.

  • Hannan, Marian T., et al. "High heritability of hallux valgus and lesser toe deformities in adult men and women." Arthritis care & research 65.9 (2013): 1515-1521.

  • Menz, Hylton B., et al. "Epidemiology of shoe wearing patterns over time in older women: associations with foot pain and hallux valgus." Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences 71.12 (2016): 1682-1687.

  • Nguyen, U-SDT, et al. "Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study." Osteoarthritis and cartilage 18.1 (2010): 41-46.

  • Hurn, Sheree E., Bill Vicenzino, and Michelle D. Smith. "Functional impairments characterizing mild, moderate, and severe hallux valgus." Arthritis care & research 67.1 (2015): 80-88.

  • Hurn, Sheree E., Bill T. Vicenzino, and Michelle D. Smith. "Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists." Journal of foot and ankle research 9.1 (2016): 1-9.

  • Hurn, Sheree E., et al. "Effectiveness of non‐surgical interventions for hallux valgus: a systematic review and meta‐analysis." Arthritis Care & Research (2021).

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Disclaimer:

Inform Podiatry provides these webpages for general advice.  Please book an appointment at Inform Podiatry for individual assessment and treatment of your foot or lower leg condition.

Key words:

Bunion | Hallux valgus

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