Merck Manual

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James C. Connors

, DPM, Kent State University College of Podiatric Medicine

Reviewed/Revised Dec 2023
Topic Resources

In people with a bunion, the joint at the base of the big toe appears to stick out (becomes prominent).

  • Abnormalities in joint position or motion can distort and enlarge or seem to enlarge the joint that connects the big toe with the foot.

  • Pain and swelling can affect the inner part of the joint or the entire joint.

  • The diagnosis is based on symptoms and an examination, and sometimes fluid in the joint is tested.

  • Changing shoes or using toe spacers, pads, or orthotic devices placed in the shoe that help redistribute and relieve pressure from affected joint, or a combination of such measures usually helps.

  • For some people with pain and difficulty walking, surgery may be considered.

A bunion occurs when the big toe and/or the bone to which it connects is out of position.

Hallux Valgus With a Bunion

A hallux valgus is when the base of the big toe abnormally points outward away from the foot and the tip of the big toe tilts in toward the second toe.

A bunion is the enlargement at the base of the big toe caused by the hallux valgus deformity.

A bursa (a fluid-filled sac) may develop over the joint and may become painful.

Hallux Valgus With a Bunion

When the base of the big toe abnormally points outward and the tip of the big toe points inward (toward the second toe), the condition is called hallux valgus. Hallux valgus causes a bunion.

Factors that contribute to bunion formation may include excessive rolling inward (pronation) of the foot, wearing tight-fitting and pointed-toe shoes, and occasionally injury. Osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) may develop, and bone spurs may form. Osteoarthritis causes joint cartilage damage, limiting the foot’s range of motion. The joint may swell, and a bursa (a fluid-filled sac) often develops and becomes painful. Tight-fitting shoes can worsen symptoms. Occasionally, gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more Gout can cause sudden attacks in which the bunion becomes red, painful, and swollen.

Symptoms of a Bunion

The first symptom of a bunion may be pain at the joint when wearing shoes that are too narrow and/or tight. Later symptoms may include increasing enlargement; a painful, warm, red swelling where the joint bulges out (bursitis); and swelling and pain all around the joint. Joint motion is usually limited.

Diagnosis of a Bunion

Treatment of a Bunion

  • Wide toe box, bunion pads, toe spacers, and orthoses

  • Sometimes, surgery to treat complications

Mild discomfort caused by a bunion may be significantly lessened by wearing shoes with a wide toe box. If not, bunion pads can shield the painful area. Toe spacers can also be tried. 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, surgery (bunionectomy) is considered.

Sometimes the fluid in a bursa is removed using a needle (aspiration).

Sometimes, surgery to release scar tissue and improve alignment is necessary.

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