What to do about bunions

William P. Huntington, MD

Foot and Ankle Surgery

If you spend a lot of time on your feet and notice a bump forming on the side of your foot, you might wonder if it’s a bunion. Known medically as hallux valgus, bunions can cause pain and discomfort, sometimes severe enough to limit your daily activities. Orthopedic foot and ankle surgeon William Huntington, MD, explained what they are and what you can do about them.

What is a bunion?

While they look like a bump or growth on the side of the foot, a bunion is formed when the bones along the front of the foot move out of place, causing the big toe to bend and twist inward. What you see is the joint of the big toe sticking out of place.

What causes bunions?

“The most common risk factors for developing a bunion include family history and wearing shoes with a high heel and narrow toe box,” Dr. Huntington said.

Other risk factors and contributing causes for bunions include:

• Trauma or injury
• Flat feet
• Rheumatoid arthritis and other inflammatory diseases
• Neuromuscular disease like cerebral palsy

Patients who are double-jointed or whose bones have developed in specific ways can also predispose them to the development of bunions later in life.

What can I do about pain from bunions?

Treatment options for bunions focus on limiting the symptoms, primarily pain. The simple truth is that there isn’t a non-surgical option that can undo the formation of a bunion. Common treatments that are successful at lessening the severity of pain include:

• Toe spacers designed to hold the great toe in a more neutral position
• Other shoe wear modifications, such as choosing to wear shoes with wider toe boxes
• Bunion sleeves, which look like a small brace and contain comfortable padding to minimize the pressure of the bunion against the side of the shoe

Dr. Huntington added that shoes can often be modified by a cobbler or an orthotist (a healthcare professional who makes or modifies braces and splints to support injured body parts) to stretch the shoes where the bunions are forming. Orthotics are also an option if the bunion leads to symptoms in the ball of the foot or is causing flat feet.

Pain can be managed with common over-the-counter medications like acetaminophen and NSAIDs like ibuprofen or naproxen.

Will a bunion heal on its own?

While it is possible, it’s uncommon for a bunion to go away on its own.

There is limited evidence that children, whose skeletons have not yet matured, can improve a bunion deformity with splinting. There isn’t any evidence, however, that such measures will work on bunions on adults.

What happens if I leave a bunion untreated?

Dr. Huntington said there isn’t a consensus on what will happen if a bunion goes untreated. Many patients with mild or moderate bunions have their condition monitored for changes but will otherwise have minimal symptoms and little change.

However, bunions can become aggravated or grow over time. Untreated bunions can begin to affect the rest of the foot more severely, including developing hammertoes or crossover toes, and the pain can grow more severe both along the sides or potentially centrally on the ball of the foot. This would make even everyday activities like walking or standing progressively more painful.

Dr. Huntington said many who seek treatment for bunions have second or third toe deformities and have begun dealing with increased pain and sensitivity.

When should I consider surgery for bunions?

“We always tell people that the three main reasons for bunion surgery are pain, pain and pain,” Dr. Huntington said. Once pain begins to impact your quality of life or disrupt daily activities, surgery may be an option to help you regain comfortable mobility.

If you feel like you are limited in what you would like to do, whether it’s at work, at home or simply out and about, consider surgery.

Surgery for the treatment of bunions is not cosmetic, and usually includes bone cuts (osteotomies) to realign the bones to their appropriate positions. This creates the right balance among the ligaments and joint capsule, which align the big toe.

While bunions are not always curable, they are treatable.