Bunions (hallux valgus)

What is a bunion?

“Bunion” describes the bump. “Hallux valgus” describes the underlying change in alignment: the first metatarsal bone (the long bone behind the big toe) angles away from the other foot bones, while the big toe angles the other way, toward the second toe. The bump is the prominent head of the first metatarsal, and the skin over it can become red, thick and sore.^[1] A similar bump can form on the outer edge of the foot at the base of the little toe; see tailor’s bunion.

The cause is not fully understood and is likely to involve several factors. Bunions run in families — up to 70% of people with bunions report a family history — and they are more common in women and in adults.^[1,2] Tight, narrow shoes may not create the deformity on their own, but they can make it worse and bring on symptoms earlier.^[4] A bunion tends to progress slowly, and no treatment is known to stop that progression.^[2]

Swipe sideways to see the whole drawing.

Symptoms

• a visible bump at the base of the big toe
• pain, tenderness or soreness over the bump, often worse in narrow or high-heeled shoes
• redness, swelling, or a burning feeling; sometimes numbness at the bump
• calluses or corns where the big toe rubs against the second toe or the shoe
• stiffness or reduced motion in the big toe joint^[1,4]

Many bunions cause few problems. The size of the bump does not always match how much it hurts, and the decision to treat depends on your symptoms rather than on how a foot looks.

How it’s evaluated

The diagnosis is usually clear from looking at the foot. The examination checks how the big toe moves, whether the joint is stiff or painful, the skin and any calluses, and how the rest of the foot and ankle are aligned. X-rays taken while you stand show how the bones are aligned under your body weight and how large the deformity is.^[1,6] Surgeons often measure two angles on these X-rays: the hallux valgus angle (how far the big toe leans) and the intermetatarsal angle (how far apart the first and second metatarsals have spread).^[7]

Other problems can cause pain in the same area — arthritis of the big toe joint (see hallux rigidus), gout, or irritation of a nerve — so the examination looks for those too.

Non-surgical care

Non-surgical care aims to reduce pressure and relieve pain. It is the usual starting point.

• Shoes: a wide, deep toe box and a low heel give the forefoot room.
• Padding: protective silicone pads worn inside the shoe cushion the painful area.
• Inserts and toe spacers: over-the-counter or custom inserts and toe spacers can reduce pressure on the bunion.
• Medication: anti-inflammatory medicines such as ibuprofen may ease pain and swelling for people who can take them safely.^[1,4]

It is worth being clear about what these measures can and can’t do. A systematic review of orthoses found not enough high-quality evidence to show that they slow progression of the deformity.^[8] An earlier Cochrane review found no clear difference between conservative treatments and no treatment on the outcomes measured, although the trials were small and of limited quality.^[9] Many people still find that better footwear and padding make walking more comfortable. See non-surgical treatment for foot and ankle problems.

When surgery is considered

Surgery is generally recommended when non-surgical measures have not relieved the pain and it interferes with daily activities.^[2,4] It is not recommended simply because a bunion is visible or to change the way a foot looks.

The evidence for surgery is limited by the number and quality of trials, but it points in a consistent direction. In an older randomized trial included in a Cochrane review, people who had a chevron osteotomy did better than people treated with orthoses or with no treatment.^[9] The 2024 Cochrane review found that, compared with no treatment, surgery may reduce pain at 12 months (average pain 21 versus 39 on a 0–100 scale), although the certainty of that evidence is low.^[3]

Surgery is not perfect. In a review of 229 studies, about one in ten people were dissatisfied after surgery and the reported recurrence rate was about 5%.^[10] Recurrence depends on how it is defined and how long people are followed. In studies that followed patients for at least five years after a distal osteotomy, 64% of feet had a hallux valgus angle above 15 degrees, but only 10% were above 20 degrees and 5% above 25 degrees.^[7] Adolescents are usually advised to wait until the skeleton has finished growing, because recurrence is more likely if the operation is done too early.^[1]

For how the operations work, what they involve and what recovery looks like, see bunion surgery.

When to seek care

Consider an evaluation if a bunion causes pain that limits walking or shoe wear, if a callus or sore keeps returning, or if the toe is becoming stiff or crowding the second toe. If you have diabetes or numb feet, have any callus, blister or sore over a bunion checked promptly.