Bunions (Hallux Valgus): Symptoms, Causes, and Treatments

What is a Bunion?

A bunion is a bony bump that most often forms on the joint of your big toe (hallux). This condition is also known as hallux valgus. It's caused by a misalignment of the toe joint, which may be due to wearing tight shoes or high heels, a foot deformity, or conditions like rheumatoid arthritis.

Besides the bony protrusion, a bunion (hallux valgus) can cause symptoms such as pain (hallux valgus pain), redness, or numbness in the affected toe.

A bunion can be very uncomfortable, so it's important to consult an orthopedist to determine the most appropriate treatment and prevent further toe misalignment that impacts daily life and quality of life.

What Comprises a Bunion?

The increased volume of the medial (inner) area near the big toe or hallux is commonly called a "bunion." When it occurs in association with outward deviation (valgus) of one or both hallux joints, it's called hallux valgus. A bunion may or may not be associated with a mechanical deformity of the big toe joint movement (hallux valgus), and this is key to understanding the cause, progression, and treatments.

What are the Symptoms of a Bunion?

Early Hallux Valgus: The condition begins with a deviation in the opening and rotation of the 1st metatarsal bone, progressing to a gradual loss of alignment of the big toe joint, with softening of the soft tissue structures, and lateral deviation. Corns can appear on the big toe and elsewhere on the foot, and due to the new space the big toe begins to occupy, the lateral toes also begin to suffer from deviations and calluses, as well as bursitis and chronic nerve inflammation. Over time, patients may be affected by stress fractures, joint wear, and even bone infarctions.

Hallux valgus pain can vary from patient to patient and isn't necessarily related to the progression or severity of the condition. Most patients experience pain due to the loss of big toe support, impaired joint movement, and the shift of weight-bearing to the lateral foot region. Some may also complain of numbness in nerve pathways, others of plantar pain or pain in other toes. Deformation of the head of the fifth metatarsal may also occur.

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What Causes Bunions?

Bunions mainly form in women aged 20 to 40 due to prolonged use of high heels, especially pointed-toe styles, as they force the big toe inward toward the other toes, making them more prominent.

This foot condition often runs in families, so those with a family history should avoid tight shoes and daily use of high heels.

People with health conditions such as rheumatoid arthritis or gout are also more prone to developing bunions and should take extra precautions.

How to Prevent Bunions?

The best way to try and prevent bunions is to wear comfortable shoes that allow your toes to move freely (hallux valgus shoes). Very high heels can also increase pressure on your toes, facilitating the appearance of bunions. It is therefore advisable not to wear heels higher than 5 cm (2 inches).

How to Get Rid of Bunions?

Surgical Method

Hallux Valgus Surgery: Hallux valgus treatment aims to restore the toe to its original position and relieve symptoms. Hallux valgus surgery is usually performed under local anesthesia. The orthopedic surgeon moves the toe closer to its original position by shaving down the deviated bone. After hallux valgus surgery, you must avoid putting weight on the operated foot for a period of time, then gradually resume daily activities. Physical therapy can be very helpful during this recovery phase.

Non-Surgical Method

Definitive treatment for hallux valgus is exclusively surgical, with several well-described techniques studied in the literature that aim to correct the characteristics of each deformity.

Clinical measures such as modified hallux valgus footwear, hallux valgus orthotics, and hallux valgus correctors, or analgesic physiotherapy techniques (hallux valgus exercises), aim to partially and temporarily relieve pain and cannot definitively correct the structural deformity; they are therefore therapies of limited use.

Using an anti-inflammatory ointment, such as Cataflan or Voltaren, may be indicated on days when high heels must be worn, but if the bunion is very large and uncomfortable, surgery may be performed as a last resort. This is especially true if the person experiences daily foot pain or has other complications, such as rheumatoid arthritis.

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