In bunion, the joint of the base of the big toe appears to stick out (becomes prominent).
People who have a bunion often have a deviated position of the big toe or the bone to which it connects. When the base of the big toe is abnormally displaced outward and the big toe points inward (toward the smaller toes), the condition is called hallux valgus (see Fig. 3: Hallux Valgus With a Bunion). Hallux valgus causes a bunion. Other factors that contribute to bunion formation may include excessive rolling inward (supination) of the ankles and occasionally injury. Osteoarthritis may develop, and bone spurs may form. Osteoarthritis may cause joint scarring, limiting the foot's range of motion. The joint may swell, and a bursa (a painful fluid-filled sac) often develops if tight-fitting shoes are worn. Occasionally, gout can cause sudden attacks in which the bunion becomes red, painful, and swollen.
Symptoms and Diagnosis
The first symptom may be painless enlargement of the joint or pain at the joint when wearing certain shoes. Later symptoms may include increasing enlargement without pain; a painful, warm, red swelling at the inner aspect of the joint; and swelling and pain all around the joint. Joint motion is usually restricted.
Doctors usually base the diagnosis on symptoms and examination findings. If the diagnosis is uncertain, x-rays are taken. If infection is suspected, doctors may withdraw and analyze joint fluid. If multiple joints are affected, tests may be done to diagnose arthritis.
Mild discomfort may be significantly lessened by wearing shoes with a wide toe box. If not, bunion pads purchased in most pharmacies can shield the painful area. Orthoses (devices placed in the shoe) can also help redistribute and relieve pressure from the affected joint. If these measures are ineffective or if the person is unwilling to wear large, wide shoes and orthoses because they are unattractive, surgery is considered. Sometimes taking nonsteroidal anti-inflammatory drugs (NSAIDs) or injecting a corticosteroid with or without an anesthetic can help relieve pain and swelling. If the joints are stiff, stretching exercises, which occasionally require injection of an anesthetic to relieve muscle spasm, can help. Sometimes, surgery to release scar tissue and improve alignment is necessary.
Last full review/revision December 2012 by Kendrick Alan Whitney, DPM