Hallux valgus

Bunions are often caused by narrow-toed, high-heeled shoes. These compress the big toe and push it toward the second toe. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe. This leads to swelling and pain. Bunions occur more frequently in women and sometimes run in families.

• Red, calloused skin along the foot at the base of the big toe
• A bony bump at this site
• Pain over the joint, aggravated by pressure from shoes
• Big toe turned toward the other toes

A doctor can usually diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot and, in some cases, arthritis.

When a bunion first begins to develop, take good care of your feet and wear wide-toed shoes. This often solves the problem and prevents the need for any further treatment. It may help to wear felt or foam pads on the foot to protect the bunion, or devices to separate the first and second toes at night. These are available at drugstores. You can also try cutting a hole in a pair of old, comfortable shoes to wear around the house.

If the bunion gets worse -- resulting in severe deformity or pain -- surgery to realign the toe and remove the bony bump (bunionectomy) can be effective. There are over 100 different surgical techniques that have been described to treat this condition.

The outlook depends on your age and activities, and the severity of the bunion. Teenagers may have more trouble treating a bunion than adults. Many adults do well by caring for the bunion when it first starts to develop, and wearing different shoes. Surgery reduces the pain in many, but not all, people with bunions.

• Chronic foot pain
• Foot deformity
• Stiff foot
• Hallux varus (occurs with surgical over-correction, where the toe points away from the second toe)

Call for an appointment with your doctor if the bunion:

• Continues to cause pain even after self care, such as wearing wide-toed shoes
• Prevents you from doing your usual activities
• Has any signs of infection (like redness or swelling), especially if you have diabetes

Avoid compressing the toes of your foot with narrow, poor-fitting shoes.

Vanore JV. Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1: Hallux valgus. J Foot Ankle Surg. 2003; 42(3): 112-123.

King DM. Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs. Foot Ankle Int. 2004; 25(4): 251-255.

Ferrari J, Higgins JP, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database Syst Rev. 2004.