Understanding Bunions: What They Are, Why They Happen, and How to Treat Them

A bunion—medically known as hallux valgus—is more than just a bump at the base of the big toe. It’s a progressive deformity in which the first metatarsal bone drifts outward while the big toe leans inward toward the other toes. This misalignment causes the MTP joint to bulge, often becoming red, swollen, and painful.

Why Do Bunions Form?

Contrary to popular belief, narrow or high-heeled shoes don’t directly cause bunions—but they can aggravate an existing tendency. Underlying genetics, foot mechanics like flat feet, loose ligaments, or joint instability are the main drivers. Medical conditions such as rheumatoid arthritis or previous foot injuries can further increase the risk.

Symptoms to Watch For

Common signs include:

• A visible bump on the inside of the foot at the big toe base
• Persistent joint pain or stiffness
• Redness or swelling around the MTP joint
• Difficulty wearing tight or narrow shoes
• Corns, calluses, or hammertoes forming on adjacent toes
• Reduced mobility in the big toe.

Diagnosis & Assessment

A healthcare provider usually starts with a physical exam and symptom history. To assess the severity, weight-bearing X-rays help measure the hallux valgus angle (HVA) and intermetatarsal angle (IMA)—key metrics in choosing the most appropriate treatment plan.

Conservative Treatment: Your First Defense

Non-surgical options are the preferred starting point:

• Wear supportive shoes with wide toe boxes and avoid pointed high heels
• Use bunion pads, toe spacers, and orthotics to cushion and realign the foot
• Apply ice, take NSAIDs to reduce inflammation, and practice foot-strengthening exercises
• Consider physical therapy, taping, or even dry needling to ease pain and improve movement.

These methods won’t reverse the deformity, but they can delay progression and relieve symptoms when used consistently.

When Surgery Is Needed

Surgery is considered only when conservative measures fail or pain severely interferes with daily life. Corrective procedures vary depending on the foot’s structure and deformity severity:

• Osteotomies (e.g., Chevron, Scarf, Akin) reposition bones and realign the toe joint
• Lapidus or joint fusion procedures may be needed for severe instability or deformity
• Minimally invasive bunion surgery (MIBS) is increasingly preferred—it offers quicker recovery, minimal scarring, and overall high patient satisfaction, especially in moderate cases. However, traditional open surgery may still be better for more severe bunions.

Recovery typically takes weeks to months, often requiring reduced weight-bearing and rehabilitation to rebuild strength and flexibility.

Why Don’t Avoid Bunion Pain

Experts emphasize that a bunion is not just a cosmetic issue—it’s a complex 3D deformity that worsens unless addressed early. Ignoring symptoms may lead to chronic pain, difficulty walking, and even postural issues.

Final Thoughts

Bunions affect nearly 1 in 4 adults and tend to run in families—but that doesn’t mean you must suffer through them. By choosing proper footwear, using protective padding or orthotics, managing inflammation, and seeking care early, you can slow progression and reduce discomfort. Surgery remains an option—but only when it's truly needed and tailored to your foot’s unique anatomy.

Your feet matter—take proactive steps to support them, and they’ll support you well.