Bunions

What a bunion is

The most common misunderstanding about bunions is that they are a growth. They are not. A bunion is a change in the position of bones that were always there. The big toe sits at the end of the first metatarsal, which runs the length of the inner forefoot. When that metatarsal angles away from the second, its head becomes prominent under the skin, and the big toe tilts the opposite way, toward its neighbors. The lump you see and feel is that bone end, often with an irritated sac of tissue over it. The medical name for the deformity is hallux valgus, described on our hallux valgus page.

Bunions tend to run in families, which points to inherited foot shape and ligament laxity as a major factor. Footwear plays a role too: narrow toe boxes and elevated heels crowd the forefoot and drive the toe into the position the deformity favors, though shoes usually accelerate a tendency rather than create one. The deformity is progressive in many people, and its consequences spread beyond the bump. As the big toe stops carrying its share of push off, load shifts to the lesser toes, producing pain under the ball of the foot, calluses, and a second toe that begins to claw.

Symptoms that often bring people in

• A visible bump on the inner side of the foot at the base of the big toe.
• Redness, swelling or soreness over the bump where a shoe presses on it.
• Difficulty finding shoes that fit, or needing a wider size than the rest of the foot.
• Aching or burning under the ball of the foot after standing or walking.
• The big toe crowding or overlapping the second toe, with calluses between the toes.

How it is evaluated

Bunions are assessed with the foot bearing weight, because the deformity looks different standing than sitting. The examiner looks at the position of the big toe and the width of the forefoot, checks how far the joint bends and whether that motion is painful, and tests whether the deformity is flexible or fixed. The lesser toes, the arch and the heel are examined too, since a bunion is often part of a broader pattern, and callus shows where load is falling. Weight bearing X-rays show the relationship between the bones and the state of the joint surface, which matters because a bunion with arthritis in the big toe joint is a different problem from one in which the cartilage is healthy.

Treatment options in general terms

Non-surgical treatment does not straighten the toe, but it addresses the symptoms and the pressure, and for many people that is enough.

• Footwear changes. A wide, deep toe box and a lower heel reduce pressure on the prominence and crowding of the toes.
• Padding and spacers. Protective pads over the bump or spacers between the toes may relieve rubbing.
• Orthoses. Inserts that support the arch and redistribute load under the ball of the foot.
• Therapy and medication categories. Stretching for the foot and calf, and anti-inflammatory options for flare ups.

Surgery is considered when pain persists and limits what you can do, rather than for the appearance of the foot alone.

• Realignment of the bones. Cutting and repositioning the first metatarsal, and sometimes the toe bone, to bring the big toe back into line and hold it with fixation.
• Soft tissue balancing. Releasing tight structures on one side of the joint and tightening the other, usually with bony realignment.
• Fusion procedures. Stabilizing the joint at the base of the metatarsal, or the big toe joint, in severe deformity or established arthritis.

What to expect when you consult Dr. Wolfson

Dr. Wolfson, MD, FRCSC, FACS, approaches a bunion as a mechanical problem in a whole foot rather than a bump to be removed. He will examine you standing and seated, review weight bearing X-rays, and explain whether your deformity is flexible or fixed and whether the joint surface is healthy, since those findings shape the options.

This page provides general information about bunions and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]