Bunion (Hallux Valgus)

A bunion, or hallux valgus, is a bony deformity that occurs at the base of the big toe joint (metatarsophalangeal joint). This condition involves the lateral deviation of the big toe toward the smaller toes, causing a prominent bump on the inner edge of the foot. Bunions develop gradually over time and can cause pain, limited mobility, and difficulty finding comfortable footwear. The deformity may also cause secondary problems such as bursitis, calluses, or hammertoes, which can affect overall foot function and gait.

Dr. Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus) | MMed (Singapore) | MRCS (Glasgow) | FRCSEd (Orth)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Bunions

Patients with bunions typically experience several recognisable symptoms that worsen as the deformity progresses.

Bony Bump

A noticeable protrusion develops on the inner side of the foot at the base of the big toe. This bump may be red, swollen, and tender to touch.
Pain and Soreness

Discomfort ranges from mild to severe and often intensifies when wearing shoes or during physical activities. The pain typically centres around the bunion area but can affect the entire forefoot.
Limited Toe Movement

The big toe may become increasingly stiff and difficult to move. This restriction in motion can affect walking patterns and balance.
Calluses and Corns

These develop where toes rub against each other or where the foot rubs against footwear. They form as a protective response to friction and pressure.
Overlapping Toes

As the bunion progresses, the big toe may begin to overlap the second toe, resulting in increased discomfort and deformity.
Inflammation and Swelling

The affected joint becomes inflamed, appearing red and swollen, particularly after long periods of standing or activity.

Causes and Risk Factors

Bunions develop due to a combination of genetic and environmental factors that affect foot mechanics and structure over time.

Hereditary Factors

The development of a bunion is significantly influenced by family history. Inherited foot types and joint structure can predispose individuals to this condition.

Improper Footwear

Regularly wearing narrow, pointed, or high-heeled shoes forces the toes into an unnatural position. This repeated pressure contributes to the development and progression of bunions.

Foot Mechanics

Abnormal walking patterns or biomechanical issues like flat feet or low arches place excessive pressure on the big toe joint. This altered pressure distribution raises the risk of developing bunions.

Occupational Factors

Jobs requiring prolonged standing or walking place additional stress on the feet. This persistent pressure can accelerate bunion formation in susceptible individuals.

Medical Conditions

Certain inflammatory conditions, such as rheumatoid arthritis, weaken the supportive tissues around the joint. This weakness allows for greater toe deviation and bunion formation.

Gender

Women develop bunions more frequently than men. This disparity relates partly to footwear choices and partly to hormonal differences affecting ligament laxity.

Diagnostic Methods

Physical Examination

Observation of the foot while standing and walking assesses alignment and function. Evaluation includes toe deviation, joint mobility, and pain locations, along with related structures to identify any secondary issues. This assessment helps determine severity and functional impact.
X-Ray Imaging

Standard weight-bearing X-rays provide detailed views of bone alignment and joint spaces. Measuring specific angles between bones quantifies the deformity, helping to assess severity and guide treatment. X-rays also detect arthritic changes that may influence treatment decisions.
Gait Analysis

Specialised observation or technology-based assessment identifies abnormal walking mechanics. This analysis reveals how the bunion affects foot function and weight distribution. Pressure mapping or computerised evaluation may be used in complex cases to refine treatment strategies.
Additional Imaging

In complex cases, MRI or ultrasound scans offer detailed insight into soft tissue involvement, including cartilage damage and inflammation. These imaging techniques assist in surgical planning or when symptoms appear more severe than the visible deformity suggests.
Blood pressure fluctuations

Both high blood pressure (hypertension) and low blood pressure (hypotension) can cause headaches and dizziness. Sudden changes in blood pressure, such as standing up quickly, may trigger these symptoms.
Anaemia

Reduced oxygen transport due to low haemoglobin levels can lead to headaches and dizziness. This condition is more common in women, particularly during menstruation or pregnancy.
Hypoglycaemia

Low blood sugar levels can trigger both headaches and dizziness, especially in people with diabetes or those who have gone for long periods without eating.
Vestibular migraine

A condition that combines migraine symptoms with pronounced dizziness and balance problems. This disorder specifically links the two symptoms through neurological mechanisms.
Concussion or head injury

Trauma to the head can cause post-concussion syndrome, with persistent headaches and dizziness lasting weeks or months after the initial injury.

Treatment Options

Management of bunions ranges from conservative approaches to various surgical procedures, with treatment selection based on deformity severity and patient factors.

Non-Surgical Treatment

Footwear Modifications: Wearing shoes with a wide, deep toe box reduces pressure on the bunion area. Proper footwear provides adequate space for the toes without compression or friction against the deformity. Custom-made shoes may benefit patients with significant deformities or other foot problems.
Orthotic Devices: Custom or over-the-counter insoles help stabilise the foot and redistribute pressure away from the bunion. These devices support the arch and align the foot more correctly during walking and standing. Orthotics address the mechanical factors contributing to bunion progression without correcting the deformity itself. They work best for mild to moderate cases when combined with appropriate footwear.
Padding and Taping: Protective pads placed over the bunion reduce friction and pressure from shoes. Taping techniques temporarily align the toe in a more correct position to relieve symptoms. These approaches provide short-term relief but do not address the underlying deformity.
Physical Therapy: Targeted exercises strengthen foot muscles and improve joint mobility. Specific stretches help maintain flexibility in the toe joint and surrounding tissues. Physical therapy techniques like ultrasound or massage may reduce inflammation and pain. Regular therapy helps optimise foot function despite the structural changes.
Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation associated with bunions. Corticosteroid injections provide temporary relief for severely inflamed joints. Medication addresses symptoms without affecting the underlying deformity. They are most effective when used in combination with other conservative measures.

Surgical Treatment

Bunionectomy: This procedure removes the enlarged portion of bone at the metatarsal head to reduce prominence while maintaining joint function. This technique improves the foot’s appearance but may not fully correct significant toe misalignment. Recovery typically takes 6–8 weeks before returning to everyday, regular footwear.
Osteotomy: This technique involves cutting and realigning the metatarsal bone to correct the abnormal angle. Different osteotomy techniques are chosen based on the severity and location of the deformity. This approach corrects both the bony prominence and toe deviation, resulting in a more comprehensive outcome. Bone healing takes 6–12 weeks, with full recovery requiring several months.

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Prevention and Management

Wearing properly fitted shoes with adequate toe room and low to moderate heels helps reduce pressure on the big toe joint. Strengthening foot muscles and maintaining flexibility support proper mechanics, while weight management minimises strain. Orthotic devices may help slow the progression of individuals with foot imbalances. For existing bunions, conservative treatments can relieve symptoms and prevent further worsening. Regular monitoring of foot changes and addressing underlying factors, such as inflammation, is essential for long-term management.

Frequently Asked Questions (FAQ)

Will a bunion go away on its own?

Bunions do not resolve without intervention. The structural misalignment remains unless surgically corrected. While conservative treatments can relieve symptoms and slow progression, they cannot reverse the deformity.

When should surgery be considered for a bunion?

Surgery may be an option if a bunion causes persistent pain that interferes with daily activities despite conservative treatment. Other factors include worsening deformity, difficulty finding suitable footwear, or complications such as hammertoes or chronic inflammation.

Can a bunion return after surgery?

Recurrence is possible and depends on the surgical technique and individual factors. Procedures that correct underlying mechanical issues are more effective in reducing the risk than simple bunionectomies. Adhering to post-operative recommendations, including proper footwear and activity modifications, helps prevent recurrence.

Dr. Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A distinguished Senior Consultant Orthopaedic Surgeon specialising in both adult and paediatric orthopaedic care.

Dr. Chua graduated from the University of Adelaide, Australia, with a Bachelor of Medicine and Bachelor of Surgery. He completed his Orthopaedic Specialist training under NUHS in Singapore in 2017.
In 2019, he was awarded the HMDP award, which enabled him to pursue a fellowship in Foot and Ankle Surgery at Oxford University Hospital NHS Trust in the UK.

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