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A bunion is a bony bump on the inside of the foot at the base of the big toe, as the toe drifts towards the others. It builds up slowly over years, and what brings people in is usually a shoe that no longer fits without hurting.
Not every painful bump near the big toe is a bunion. Four conditions are commonly confused, and they are treated differently. Where the bump sits, and what movement hurts, usually separates them.
| Bunion hallux valgus | Stiff big toe hallux rigidus | Gout crystal arthritis | Bunionette little toe side | |
|---|---|---|---|---|
| Where the bump is | On the inside of the big toe joint | On top of the big toe joint | No lasting bump; the joint swells | On the outside, at the little toe |
| Which way the toe points | Drifts towards the second toe | Straight | Straight | Little toe drifts inwards |
| What hurts | Pressure from the shoe on the bump | Bending the toe up — walking uphill, pushing off | The whole joint, severely | Pressure on the outside of the shoe |
| How it came on | Slowly, over years | Slowly, with stiffness first | Suddenly, often overnight | Slowly, over years |
| The underlying problem | The shape of the foot | Wear in the joint | Uric acid crystals | The shape of the foot |
A bunion does not turn red, hot and exquisitely tender overnight. If the big toe joint does that, it points to gout or an infection instead, and a hot joint with a fever should be seen the same day. Call the clinic and come in.
The long bone behind the big toe — the first metatarsal — gradually drifts towards the other foot, while the big toe itself tilts the opposite way, towards the second toe. The joint between them ends up angled, and its inner edge pushes out against the shoe.
What a picture cannot show is that the bump is mostly not new bone. It is largely the end of that drifting metatarsal, left exposed as the bone moves out of line. That is why simply shaving the bump off tends to disappoint: the angle that made it is still there.
It is also why the deformity slowly gets worse rather than settling. Once the joint is angled, the tendons that move the big toe pull it further in the same direction with every step.
Most are managed without an operation. The aim is to stop the bump hurting, not to change its shape, and for many people that is enough.
A wide, deep toe box, a soft upper over the bump and a low heel take the pressure off. This is the single most effective thing for bunion pain, and it costs nothing clinically. It will not change the shape, but it often makes it comfortable.
A gel pad over the bump, or a spacer between the first and second toes, reduces rubbing. Night splints are widely sold, but in adults they do not permanently straighten the toe — the correction lasts only while they are worn.
When the pain persists despite sensible shoes, or it stops you walking or working comfortably. Not for the way it looks: one that does not hurt is usually best left alone, because surgery carries a recovery and some risk of its own.
Most operations realign the drifted bone by cutting and repositioning it, rather than just removing the bump. Where the joint is badly worn, fusing it may give a more reliable result. You can usually walk in a protective shoe soon afterwards, but full recovery takes several months, swelling lingers, and the deformity can occasionally return.
Bunions here are seen by Dr Jeffrey Tan Gek Meng, a Senior Consultant Orthopaedic Surgeon whose subspecialty is foot and ankle, and whose work includes bunion correction. He is a Fellow of the Royal College of Surgeons of Edinburgh, completed his subspecialty fellowship in foot and ankle surgery at Toronto Western Hospital, and consults in English, Mandarin, Malay, Hokkien and Hainanese.
Not on their own. The tendency to develop one comes mainly from the inherited shape of the foot. Narrow, pointed or high-heeled shoes do make one hurt sooner and can make it progress faster, which is why changing shoes helps even though it will not reverse it.
No. They can relieve rubbing and pain while you wear them, but in adults they do not permanently correct the angle of the bone. Only surgery changes the shape.
Usually not. Surgery is recommended for pain and for difficulty walking or wearing shoes, not for appearance. One that is comfortable in sensible shoes is generally best left alone.
You can usually walk in a protective shoe soon after the operation, but getting back into normal shoes takes weeks, and swelling can take several months to settle fully. The timeline depends on which procedure is done.
It can, though it is uncommon when the underlying angle has been corrected rather than just the bump removed. That is one reason the operation realigns the bone.
No. Bring any X-rays you have, and wear or bring the shoes that cause you the most trouble — they show exactly where the pressure falls.
Foot pain · Gout · Ankle pain
Bring the shoes that hurt most. They show exactly where the pressure falls, which is half of the first consultation.
