What is bunions?

A bunion is a bump on the outside of the joint at the bottom of your big toe. It can cause pain and swelling in the toe. A bunion forms when bone or tissue around the joint becomes swollen from too much pressure. You also can have a bunionette, or tailor's bunion, which forms on the joint of the little toe. Sometimes, a bunion on the big toe turns the toe in toward the second toe. This is called displacement. It can lead to problems with the other toes.

You can get a bunion from having an unusual walking style, having flatfeet, or wearing tight-fitting shoes. You can treat most bunions at home with a few simple steps. If you have a lot of pain, your doctor may inject medicine into the bunion to reduce swelling for a while. If you still have pain, you may need to have surgery.

Your bunion may not cause any symptoms. If you do have symptoms, they may include:

• Pain in your big toe.
• Red or irritated skin over the bunion.
• Swelling or enlargement of the metatarsophalangeal joint at the base of the big toe.
• Displacement of the big toe, so that it points toward the other toes and causes problems in other toes, such as hammer toe.
• Joint pain or stiffness.

A bunionette can cause similar symptoms at the base of the little toe.

Bunions and their symptoms develop slowly over time.

Bunions are treated to ease pain and help with walking and other daily activities. Most bunions can be treated at home.

Home treatment includes wearing shoes that have wide and deep toe boxes (the area that surrounds the toes). The shoes should have low or flat heels and good arch supports. You can wear pads or splints to cushion the bunion and take pressure off the toe.

Applying ice and taking over-the-counter medicine can help relieve toe pain.

Avoid activities that put pressure on your big toe and foot. Try activities that don't put a lot of pressure on your foot, such as swimming or biking.

If you have a bunion but don't have pain or discomfort, treatment may not be needed.

Surgery is an option only if other treatments don't help. Bunion surgery is done to help restore normal alignment to the toe joint.

Proper footwear may prevent bunions. Wear roomy shoes that have wide and deep toe boxes (the area around the toes). The shoes should have low or flat heels and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint. Medicine won't prevent bunions.

Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be:

• When did the bunions start?
• What activities or shoes make your bunions worse?
• Do any other joints hurt?

The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. To rule out other problems, your doctor may also check your reflexes, your pulse, and your feeling in the foot.

Tests that may be done

X-rays are often used to find out the degree of bone deformity or to rule out other causes of pain and swelling. If surgery is being considered, X-rays can help your doctor decide what type of surgery will be most helpful in treating the symptoms. X-rays usually are done while you are standing so that the foot is bearing weight. In some cases, an MRI, a CT scan, or a bone scan is also used.

More tests, such as blood tests or arthrocentesis (removal of fluid from a joint for analysis), are sometimes done if other conditions that can cause joint pain and swelling are suspected. These other conditions include gout, rheumatoid arthritis, and joint infection.

• Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.
• Wear shoes that have a wide and deep space for the toes. Also, wear shoes that have low or flat heels and good arch supports. Do not wear tight, narrow, or high-heeled shoes.
• Try bunion pads, arch supports, toe spacers, or shoe inserts. They can help shift your weight when you walk to take pressure off your big toe.
• Put moleskin or another type of cushion on or around the bunion to keep it from rubbing against your shoe.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time as needed. Put a thin cloth between the ice and your skin.
• Prop up your foot on a pillow when you ice your toe or anytime you sit or lie down. Try to keep it above the level of your heart. This will help reduce swelling.

Bunion surgery generally involves making a cut (incision) in the top or side of the big toe joint area. Then soft tissue and bone are removed or realigned. You may consider surgery if your bunion causes lasting, severe pain that limits your daily activities. You may also consider it if you have a severe foot deformity.

The goals of surgery for bunions are to:

• Relieve pain and restore normal alignment to the toe joint.
• Restore, as much as possible, normal weight-bearing distribution to the foot.
• Allow you to return to normal activities.

Surgery isn't recommended if you:

• Haven't tried nonsurgical treatment.
• Have other health problems that make surgery dangerous. If you have diabetes, neuromuscular disorders, or circulatory problems that limit blood flow to your feet, talk with your doctor about the risks of surgery. Such conditions increase the chance of problems from surgery.
• Have unrealistic expectations about the results of surgery (such as being able to wear any kind of shoe).

Here are some things to think about when you decide whether to have surgery:

• The type of surgery used depends on how severe the bunion is. It also depends on your surgeon's experience. Look for a surgeon who does many different types of bunion surgery on a regular basis. Each bunion is different, and surgery needs to be tailored to each case. Research doesn't show which type of surgery is best.
• Bunions may come back after surgery. This is more likely if you keep wearing narrow or high-heeled shoes.
• What you expect may influence how satisfied you are with the surgery. For example, surgery may improve how your foot looks. But people who make appearance their main reason for surgery are often disappointed in the results. Talk with your doctor about what you expect.
• Surgery may reduce the flexibility of the big toe joint. This may be a concern if you are active and need a full range of motion in the big toe.
• You will have to stay off your foot for a while after surgery.

You may get bunions if there is too much pressure on the big toe joint. This can happen if the shape of your foot puts pressure on your big toe, if your foot rolls inward when you walk, if you have flat feet, or if you wear shoes that are too tight.

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. The big toe may turn toward the second toe. The tissues around the joint may be swollen and tender.

A bony bump at the base of the little toe is called a bunionette or tailor's bunion. The little toe also bends inward, and the joint swells or enlarges.