A bunion is a bony bump at the base of the big toe. Cleveland Clinic estimates that about one in three Americans has one. Most bunions can be managed without surgery, and an operation is usually kept for pain that doesn’t get better.
See a doctor promptly if a bunion turns red, warm or swollen, especially if you have diabetes. MedlinePlus, from the National Library of Medicine, lists signs of infection as a reason to contact a provider. The American Podiatric Medical Association (APMA) notes that in people with diabetes, foot deformities such as bunions raise the risk of ulcers, and nerve damage can hide the pain.
In the video above, a patient of podiatrist Dr. Reza Mobarak describes living with a painful bunion and having a bunionectomy, an operation to straighten the big toe.
What a bunion is
The medical name is hallux valgus. Over time the big toe leans toward the second toe, the bones shift out of line, and the joint at the base of the toe gets larger and can become inflamed. Bunions usually develop slowly, tend to get worse and don’t go away on their own.
Causes and risk factors
Most bunions have more than one cause:
- Family history. The American College of Foot and Ankle Surgeons (ACFAS) explains that people inherit a foot type that is prone to bunions, not the bunion itself.
- Sex. Bunions are more common in women.
- Footwear. The American Academy of Orthopaedic Surgeons (AAOS) lists tight shoes as a cause. ACFAS says crowded shoes make bunions worse but don’t cause them.
- Other factors, such as flat feet, rheumatoid arthritis, past foot injuries and long hours of standing.
Symptoms
Besides the bump, a bunion can cause pain, swelling, redness, burning or numbness, a stiff big toe, corns or calluses, and trouble finding shoes that fit. The big toe may crowd or cross over the second toe. Symptoms often flare in tight shoes, and some people never have any.
How a bunion is diagnosed
A doctor can usually recognize a bunion during an exam. X-rays, ideally taken while you stand, show how severe it is and whether the joint has arthritis.
Care without surgery
AAOS says most bunions are treated without surgery. These steps can ease pain and may slow the bunion down, but they don’t straighten the toe:
- shoes with a wide, deep toe area, and no pointed toes or high heels
- pads over the bump, toe spacers, taping, shoe inserts or a night splint
- ice wrapped in a thin towel
- over-the-counter anti-inflammatory pain relievers, if your doctor says they’re safe for you
- physical therapy, and avoiding activities that bring on pain
A bunion that doesn’t hurt may simply be watched, with regular checkups.
When surgery is considered
Surgery is usually considered when pain continues despite these steps and makes walking or daily activities hard. AAOS says a bunion that doesn’t hurt doesn’t need surgery, and that surgery shouldn’t be done for cosmetic reasons.
A bunionectomy removes the bump and realigns the big toe. MedlinePlus notes that there are more than 100 techniques. In a common one, an osteotomy, the surgeon cuts and shifts the bone and holds it with screws, pins or plates. Severe bunions or arthritis may call for fusing the joint. Minimally invasive surgery uses smaller incisions; AAOS says long-term results appear similar to open surgery, but it isn’t right for every bunion.
Your surgeon chooses based on your X-rays, age, activity level and the bunion’s severity. Most patients go home the same day.
What recovery involves
Recovery depends on the procedure but often includes:
- a dressing that holds the toe in position and must stay clean and dry
- a surgical shoe, boot or cast, in some cases for up to eight weeks
- limits on putting weight on the foot, with crutches or a knee scooter
- keeping the foot raised to control swelling
- exercises or physical therapy
Cleveland Clinic says most people return to usual activities in about two to three months. Swelling can last up to a year, and you may need roomy shoes long-term. Most people have less pain and a straighter toe, but surgery doesn’t relieve pain for everyone. Possible complications, described as rare, include infection, nerve damage or numbness, stiffness and the bunion coming back.
Call your surgeon for fever or chills; redness, warmth, drainage or bleeding at the incision; pain that keeps getting worse despite medicine; a dressing that comes loose or gets wet; or calf swelling, pain or redness. AAOS advises calling right away for shortness of breath. Mention any numbness, too.
The patient’s story
The patient in the video says that before surgery he couldn’t walk well, run or jog. His foot pointed to one side and the bone stuck out. Dr. Mobarak was recommended to him, and he had a bunionectomy to straighten the foot.
About a month later, he says, his foot was straight and he was wearing a shoe. His advice is to follow your doctor’s instructions, and he praised how well the staff communicated with him.
This is one patient’s experience, and results vary. AAOS notes that recovery depends on the procedure and on following your surgeon’s instructions.
Questions to ask your doctor
- Is this a bunion, and how severe is it on my X-rays?
- Am I a candidate for surgery? Which procedure would you recommend, and why?
- When can I put weight on my foot, drive, go back to work and exercise?
- What are the risks, including the chance the bunion comes back?
- I have diabetes or another health condition. Does that change my care?
- Which warning signs after surgery should make me call you?
Dr. Mobarak is a podiatrist and foot and ankle surgeon at Southwest Foot & Ankle Center in Lewisville, Texas. See Dr. Mobarak’s Best Docs Network profile for more about the practice.
Sources
- Cleveland Clinic. Bunions (Hallux Valgus).
- Cleveland Clinic. Bunion Surgery (Bunionectomy).
- American College of Foot and Ankle Surgeons, FootHealthFacts.org. Bunions.
- American College of Foot and Ankle Surgeons. Bunion Deformity.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Bunions.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Bunion Surgery.
- American Podiatric Medical Association. Bunions.
- American Podiatric Medical Association. Diabetic Wound Care.
- MedlinePlus (U.S. National Library of Medicine). Bunions.
- MedlinePlus (U.S. National Library of Medicine). Bunion removal.
- MedlinePlus (U.S. National Library of Medicine). Bunion removal - discharge.
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
