What Are Bunions? Symptoms, Causes, Diagnosis, Treatment, and Prevention

A bunion is a physical deformity that occurs when the big toe moves and points toward the second toe. This deformity causes a bony bump on the outside edge of the big toe, near its base. It is most commonly due to outside pressure on the big toe joint.

The condition can affect anyone, but it’s associated with wearing high-heeled or narrow shoes.

Bunions develop when pressure on the big toe joint causes the big toe to lean toward the second toe.

Eventually, the structure of the bone in the big toe changes and gives rise to a bunion. This deformity will gradually worsen and may make it painful to wear shoes or walk.

Although bunions usually start out small, wearing tight, narrow shoes can cause them to grow. They tend to grow slowly. The bigger a bunion gets, the more painful and difficult walking can become.

Symptoms of bunions include the following:

• Pain in the joint of the big toe, which gets worse while wearing tight-fitting shoes
• Trouble walking normally or moving the big toe normally
• Inflamed (red and thickened) skin along the outside edge of the big toe
• Numbness of the big toe
• A burning feeling
• Calluses where the toes rub together

As bunions worsen, they can greatly alter the appearance of your foot. With severe bunions, your big toe may angle all the way under or over the second toe.

Pressure from the big toe may force the second toe out of alignment and cause it to angle toward the third toe. Calluses can develop where the toes rub against each other, causing additional discomfort and problems with walking.

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• Wearing high-heeled shoes that force your toes into the front of your shoes
• Wearing tight-fitting shoes that are too narrow or too pointed
• Having rheumatoid arthritis
• Having a family history of a problem with the structure or anatomy of your foot

A genetic predisposition in certain foot shapes and structures may lead to bunions. Bunions appear to run in families.

Other conditions or situations that contribute to bunion development include having flat feet, low arches, loose joints or tendons, or other foot injuries.

Bunions can also be caused by other health problems affecting the feet, including gout and psoriatic arthritis. People with connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, and those with Down syndrome may be at an increased risk for developing bunions, as are people who have a muscle imbalance in the feet due to conditions such as cerebral palsy or Charcot-Marie-Tooth disorder.

If you have any of these underlying foot health issues, wearing tight shoes may exacerbate a developing bunion by keeping the big toe in the incorrect position.

Your doctor should be able to diagnose a bunion from a routine physical examination of the foot.

After an exam, your doctor may take an X-ray of your foot to determine the best treatment approach.

You may need an ultrasound if there is numbness or tingling; this test can help confirm whether there’s nerve damage in the foot.

Prognosis of Bunions

If you have mild symptoms or a small bunion, the prognosis is excellent. If your bunion requires surgical intervention, the prognosis is also excellent. Surgery can provide long-term relief from the discomfort and deformity a bunion causes.

The treatment of bunions is typically based on the severity of the deformity and symptoms.

The initial treatment of bunions, particularly those that are small or have mild symptoms, is normally conservative and focuses on relieving symptoms. These nonsurgical measures may include the following:

• Wearing wide-toed shoes
• Having shoes professionally stretched to provide more room
• Using padded shoe inserts or other orthotic devices that help distribute pressure evenly while you walk
• Avoiding activities that cause pain, such as sports
• Applying warm soaks or ice packs

Over-the-counter nonmedicated bunion pads or cushions are designed to act as a buffer between your foot and your shoe to ease any pain or discomfort.

Your doctor may also recommend custom-fit toe spacers or bunion splints. These special corrective devices slip into your shoes to push the big toe back into its proper position.

If these approaches fail to relieve the pain and discomfort caused by your bunions, or if the bunion leads to other problems, your doctor may recommend surgery. There are many surgical procedures that can resolve bunions.

In a bunionectomy, a surgeon shaves off the excess bone on the outside of your first metatarsal bone (the bone in the foot just next to the big toe) and realigns the muscles, tendons, and ligaments of your big toe.

If your bunion is moderately deformed, your surgeon will also cut the bone close to the metatarsal head (the top of the first metatarsal bone) to move it into the proper position. Your bone will then be held in place with screws or pins while you heal.

For severe bunions, your surgeon will cut away the excess bone of your first metatarsal head and a wedge-shaped piece of bone at the base of your first metatarsal. Your surgeon will then realign your metatarsal bone and secure it in place with screws or pins before correcting your muscles, tendons, and ligaments.

It’s possible that you’ll need to be on crutches for a short period of time in order to keep your weight off your foot. As mentioned above, full recovery — including the ability to walk without pain or discomfort — can take weeks to months.

To prevent bunions from returning, you’ll need to wear proper shoes after surgery. For most people, it’s unrealistic to expect to wear narrow or high-heeled shoes after bunion surgery.

Medication Options

There are no medications that can cure or resolve bunions on their own. However, if your bunions are causing pain, your doctor may recommend over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil) or naproxen (Aleve). Yet, there can be risks to taking these drugs longer term.

For more severe bunion pain, your doctor may administer cortisone (Cortone Acetate) injections intermittently.

Prevention of Bunions

The best way to prevent bunions is to wear shoes with a wide toe area and extra space between the tip of your longest toe and the end of the shoe. Shoes should also conform to the shape of your feet, without too much pressure.

Wearing proper shoes is particularly important if you have a family history of bunions or if you have another health condition that increases your risk for developing them.

Doing so may not prevent bunions entirely, but it can help reduce your risk for them.

Bunions start off small and grow over time if they’re not treated. As a bunion grows, it becomes more painful.

As a result, it may be difficult to walk.

In the most severe cases, the big toe may extend over or below the second toe, possibly putting pressure on the second toe that pushes it out of alignment and against the third toe.

Left untreated, a bunion may also cause these conditions:

• Bursitis, in which the bursa (a fluid-filled sac that cushions bones, tendons, and muscles near joints) of the big toe becomes inflamed and painful
• Hammertoe, an abnormal bend in the joint of the toe
• Metatarsalgia, an inflammation of the ball of the foot

RELATED: How to Treat Bursitis, Whether Caused by Psoriatic Arthritis or Not

Research suggests that Black Americans are more likely to develop bunions compared with white Americans.

People with flat feet, low arches, loose joints or tendons, or other foot injuries may be at an increased risk for bunions.

Bunions can also be caused by other health problems affecting the feet, including gout, psoriatic arthritis, and rheumatoid arthritis (RA).

In addition to placing you at an increased risk for bunions, gout and RA are sometimes misdiagnosed as bunions, and vice versa.

Although gout can strike in any joint, it most commonly affects the big toe, and its symptoms (pain, inflammation, and redness) are similar to those of a painful bunion.

RA and osteoarthritis affect multiple joints, but they both often first develop in the smaller joints of the feet, including those in the big toe.

People with connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, and those with Down syndrome may also be at an increased risk for developing bunions, as are people who have a muscle imbalance in the feet due to conditions such as a stroke, cerebral palsy, or myelomeningocele.

The American Podiatric Medicine Association’s site can help you find a podiatrist and learn more about conditions of the feet and ankles.

The American Orthopaedic Foot and Ankle Society maintains FootcareMD.org, a site that provides comprehensive information on a variety of conditions affecting the feet (it also includes a symptom checker).