What Are Bunions? And How to Treat Them

Bunions—maybe your grandma used to complain of foot pain and mentioned bunions a few times, or perhaps you remember hearing someone talking about bunions in a healthcare provider's office. It's not a subject that's likely to come up in everyday conversation. But if you're dealing with foot pain and you notice that the bone at the base of your big toe is starting to look enlarged, you may just be dealing with a bunion.

Even though bunions may not be everyday dinner table conversation, the condition is incredibly common. According to an article published in the Journal of Foot and Ankle Research, a little less than one-quarter of the population between 18 and 65 have a bunion (also known as hallux valgus). More than a third of the population over 65 experience this foot deformity. And while bunions can be painful and make it harder to find shoes, there are ways to manage the pain and help prevent the progression. Here's what you need to know.

Understanding Bunions

Hallux valgus is one of the most common foot deformities there is, and its primary sign is a firm bump, along with redness, swelling, and pain, at the joint at the base of the big toe.

"Bunions are caused by a genetic predisposition that causes the big toe to shift internally out of place," explains Nelya Lobkova, DPM, a board-certified podiatric surgeon at Step Up Footcare in New York City. "Due to this shift, there is only a small portion of the big toe articulating with the first metatarsal. The non-articulating surface of the joint grows bigger and becomes the prominent and characteristic 'bump' associated with bunions."

Dr. Lobkova explains that this bump can cause numbness and tingling in the big toe as the bone presses against the nerve while wearing most shoes. This bump also creates a wider forefoot that can make it difficult to find footwear that allows the space necessary to prevent rubbing and discomfort.

While a single, exact cause of bunions hasn't been determined, there are quite a few risk factors for developing the deformity.

• Genetics: If your grandmother has a bunion, the probability that you could end up with a bunion is increased, says Dr. Lobkova. "The most agreed upon cause of the bunion deformity is genetic inheritance. Thus, bunions tend to run in families."
• Gender: Women are more likely than men to experience bunions. Plus, pregnancy can actually make bunions worse, says Dr. Lobkova. "When women have children, relaxin is released throughout the body, which relaxes the ligaments in the body. This hormone contributes to worsening of joint deformities, such as bunions."
• Rheumatoid arthritis: Rheumatoid arthritis, which is an autoimmune arthritis, causes increased inflammation in the joints. "The inflammation in the joint causes erosion of bones and bony deformity, which often results in severe bunions," says Dr. Lobkova.
• Ill-fitting shoes: While shoes that are tight at the forefoot don't cause bunions, they can worsen the deformity, Dr. Lobkova adds. "Shoes with a narrow toe box press against the joint and irritate the capsule overlying the bones. They also exaggerate the inward motion of the big toe which increases the displacement of the toe seen in bunion deformities."
• Flat feet: If the arch on your foot is flat, has fallen, or is practically non-existent, you may be more inclined to develop a bunion due to other mechanical imbalances. "The foot has many muscles that have to maintain a balance with each other, once that balance is thrown off for any reason, a bunion can form," explains Sondema N. Tarr, DPM, a board-certified podiatrist practicing at Direct Podiatry Arizona in Tempe, Arizona.

Both Dr. Tarr and Dr. Lobkova emphasize that bunions are progressive deformities. This means that over time, the deformity becomes worse, and can even become debilitating. Consequently, older adults who may be more susceptible to bunions should choose footwear, like walking shoes for seniors with a more spacious toe box.

"Sometimes a bunion can be so severe that it causes the big toe to cross over and actually sit on top of your second and third toes," says Dr. Tarr. "This can make it very difficult to walk pain-free, or even to find shoes that fit. That said, the rate at which progression takes place can vary significantly from person to person, and home remedies can help slow the progression and improve symptoms."

Signs and Symptoms

The primary symptoms of a bunion include pain, redness, and an enlarged bony bump at the base of the big toe that juts out to the side. The American Podiatric Medical Association notes the following common symptoms:

• Swelling or firm bump at the outside edge of the foot at the base of the big toe
• Redness, swelling, or pain at this joint (known as the metatarsophalangeal joint, or the MTP joint)
• Development of hammertoes at the second toe
• Development of calluses under the ball of the foot
• Development of corns or irritations caused by the big toe overlapping the second toe
• Restricted or painful motion of the big toe

Many of these symptoms, like the development of hammertoe, calluses, or corns, take time to develop, says Dr. Lobkova. "[Because] the bunion causes the big toe to shift inward toward the second toe, eventually the second toe has to get out of the way. This causes the second toe to lift and the big toe to lie between it. Thus, the second toe becomes a hammer toe."

Diagnosis and Assessment

While you may suspect you have a bunion, it's best to seek medical care to confirm an assessment and possibly to determine the extent to which the deformity has progressed. A physical examination by a healthcare provider is all that is needed to diagnose a bunion, explains Mauricio Garcia, MD, an orthopedic surgeon and the senior project manager for Hyper Arch Motion shoes. "An x-ray also may be taken to define staging, prognosis, and treatment. Because bunions can be hereditary, detailed family history is also an integral part of diagnosis and treatment."

Bunion deformity can be categorized into four stages following a doctor's examination, with stage 1 being the most minor, and stage 4 indicating the furthest progression.

• Stage 1: Lateral displacement of the big toe at the MTP joint
• Stage 2: Progression noted with the big toe pressing against the second toe
• Stage 3: A greater angle at the intermetatarsal—hammertoe of the second toe may be observed
• Stage 4: A partial or complete dislocation of the big toe at the MTP joint

As the stages progress, there's a greater likelihood of other complications and problems. "The imbalance and friction caused by bunions can lead to other foot conditions such as bursitis, hammertoes, and metatarsalgia," says Dr. Garcia.

Non-Surgical Treatment Options

The good news is there are a wide range of non-surgical treatment options that are both inexpensive and effective at helping control the progression of bunion deformities. That said, response to treatment is different for everyone, and some options may work better than others based on your personal situation. Dr. Lobkova points to the following common treatments.

Bunion Correctors

These splints can help prevent additional rubbing or irritation at the MTP joint, but they're not always comfortable or easy to wear, she says. "Look for soft materials like gel or neoprene instead of plastic applicators which rub and irritate the skin. I also recommend correctors that don't actually go over the medial 'bump' or bunion. The skin overlying the bump is very sensitive and should not have any additional tension on it to avoid skin breakdown."

She even points out that you can use kinesio tape as a bunion corrector and it can be worn while exercising and with all types of shoes. "Applying kinesio tape works to realign the misaligned joint and compress the painful tissue overlying the bunion 'bump.' You can also shower and sleep with kinesio tape on your foot, without worrying about cutting off circulation or macerating (moistening) the skin from occlusive irritation."

Stretching and Physical Therapy

Stretching the calf and the arch of the foot can help reduce pressure on the bunion and may help correct muscle imbalances that could be contributing to the deformity's progression, says Dr. Lobkova. "I love the resistance band stretch. This stretch is done standing with the feet hip-width apart. Use a resistance band around both big toes and perform double heel lifts." She recommends doing three sets of 12 lifts. You can also stretch the ligaments in the toes by using toe separators or yoga toes at rest, she says.

While you can try stretching on your own, it may be a good idea to enlist a physical therapist to help you learn the right stretches and to make sure you're performing them correctly, says Dr. Garcia. "Physical therapy helps with bunions by providing exercises and stretches that improve foot and toe flexibility, as well as strengthening the supporting muscles around the joint. Physical therapists can also offer tailored guidance on proper footwear and any necessary activity modifications."

Wearing the Right Shoe

Likely the first recommendation a healthcare provider will give you is to change your footwear, says Dr. Lobkova. "Choosing the right footwear can prevent pain and disability with bunion deformity." Wide toe box shoes, for instance, offer plenty of space for feet to splay out.

It also allows for normal toe flexion, without crowding the toes, which will help maintain a healthy joint, she adds. "In addition, wearing footwear with arch support, especially along the inside of the foot, slows down the progression and worsening of the bunion deformity. Arch support contributes to metatarsal stability and minimizes wear and tear of the big toe joint." For instance, consider New Balance shoes which feature wide toe boxes, plush cushioning, and arch and forefoot support.

According to Dr. Lobkova, the right footwear should include the following features:

• A wider forefoot to allow ample space for the bunion deformity
• Soft upper material to prevent uncomfortable rubbing at the joint and to reduce pain and irritation
• A 1-inch heel that lifts the heel slightly to help put the foot in a more biomechanically appropriate position, taking pressure off the MTP joint
• Open-toed shoes and sandals with appropriately placed sandal straps — the straps should not rub against or irritate the bunion
  

Getting Orthotics

Custom orthotics that are designed especially for your foot (and your bunion) can help by correcting your foot alignment. This also can help reduce pain and the progression of the bunion.

"Custom orthotics can include specific modifications for bunions, for instance, a deeper cut out under the big toe joint to allow for more room in the shoe and an increase in range of motion," says Dr. Lobkova.

Custom is the keyword here. Over-the-counter options may seem to take some of the pain away, but without specific bunion modifications, they're unlikely to provide much support or offer longer-term assistance with bunion progression.

Pain Management Strategies

Some of the first pain management strategies you should try are also the non-surgical options like changing your shoes, trying kinesio tape, and starting a stretching or physical therapy protocol.

"Maintaining a healthy weight, engaging in foot exercises and stretches, and using orthotic devices or shoe inserts for proper foot support are good ways to manage bunion pain," says Garcia.

But it's important to realize that the pain, especially in the earliest stages of the deformity's progression, is largely coming from irritation and inflammation. That means that common strategies to reduce pain caused by inflammation for other conditions will work for bunions, too.

For instance, OTC pain relievers like ibuprofen or acetaminophen, topical pain relievers like Bengay or Icy Hot, foot soaks, and ice packs can all offer some relief.

Surgical Treatment Options

According to Dr. Tarr, there are only three procedures that are typically used for bunions, each carrying its own risks and benefits, so it's important to work with a healthcare provider to determine which procedure might be right for you.

"It's more important that the podiatrist matches the right patient to the right kind of procedure," she says. "One surgery on two different people could have two very different results, long-term." Here are a few of the options available:

• Arthroplasty: In this surgery, the joint is removed and replaced partially or fully to help maintain the joint range of motion. The most common version is the Keller resection where post-op approximately 75% of patients are satisfied with the results and 88% experience complete relief from the pain. That said, roughly 12% of patients experience an increase in pain post-surgery.
• Osteotomy: A surgeon cuts into the big toe bone to put it into a less adducted position. Most patients experience a normal angle at the hallux after 12 months, with an 80% satisfaction rate. That said, 61% of patients experience footwear problems afterward. Patients opting for this procedure also have the highest foot care medical expenses, and more days spent out of work.
• Arthrodesis: This surgery involves fusing the MTP joint into the correct position. This surgery is only appropriate when the original joint is severely degenerated and other surgeries or options are unlikely to result in an improvement in functionality. For this reason, it's typically reserved for older patients. Post-op, more than 80% of patients experience pain relief and improved movement. That said, about 20% of patients experience other complications, limited footwear options, pain under the ball of the foot, and joint stiffness.
  

Preventive Measures and Lifestyle Tips

While preventing all bunions may not be possible thanks to their genetic, mechanical, and disease-related causes, that said, there are ways to work to prevent progression. Consider the following measures:

• Choose footwear with sufficient space at the forefoot that doesn't rub or irritate the MTP joint.
• Maintain a healthy weight to help prevent extra stress and strain on the feet.
• Stretch your feet and lower body regularly to help keep your muscles and joints flexible and well-balanced.

"The best way to prevent bunion progression is if you see changes to your feet, see your local podiatrist," says Dr. Tarr. "They can advise you on how to proceed to prevent further progression in order to avoid surgery."

Bottom Line

If you've noticed a bump at the bottom of your big toe that seems red, irritated, or painful, it's time to make an appointment with a podiatrist to assess whether you're dealing with a bunion. While bunions are progressive, when they're caught and addressed early, you have a better chance of managing the progression and avoiding major intervention (like surgery) long-term.