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Bunion deformity

When the big toe joint hurts, is swollen, and your foot only fits in wide shoes, your foot may be telling you “you have a bunion”. More than half the women in America complain of having bunions.  This is a common deformity often blamed on wearing tight, narrow shoes, and high heels. Bunions may occur in families, but many are made painful from wearing tight shoes. Nine out of ten bunions happen to women. Nine out of ten women wear shoes that are sized too small. Excessively tight shoes can also lead to other painful foot problems like corns, calluses and hammertoes.


The term ‘bunion’ refers to the enlargement on the inside edge of the foot.  This is caused by a deformity of the alignment of the first foot bone (metatarsal) and toe bone (phalanx).  The metatarsal bone deviates inward while the toe angles outward.  Normally the metatarsal and phalanx bones are in line with each other.  In the case of a bunion deformity the two bones form an angle with the apex pointing inward. The skin over it may be red and tender. Wearing shoes may be painful and the higher the heel or the tighter the toe box, the more pressure on the deformity. This joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk. Bursitis refers to an inflammation over the bump. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful. Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. This deformity causes an instability which can cause slow progression of the deformity. This deformity causes not only pain but also can cause difficulty walking.


Adolescent Bunion

Most of the time we consider a bunion as something that only adults can get from wearing the wrong kind of shoes but, a young teenager (especially girls aged 10-15) may develop an adolescent bunion without having worn tight shoes. Unlike adults with bunions, a young person normally does not develop stiffness of the joint. An adolescent may have pain and trouble wearing shoes similar to adults. Surgery to correct an adolescent bunion is not recommended unless your child is in extreme pain and the problem does not get better with changes in shoe wear. Generally surgery on adolescent bunions is done after the bones are finished growing because there is a good chance the deformity to recur.



Pain relief from bunions

Most patients with bunions prefer to treat them without surgery. Preventing the deformity is always best. To minimize your chances of developing a bunion, never force your foot into a shoe that doesn't fit. Choose shoes that conform to the shape of your feet. When you buy shoes, check for a good fit and for shoes with wide insteps, broad toes and soft soles. Avoid shoes that are short, tight or sharply pointed, and those with heels higher than 2 inches. If you already have a bunion, wear shoes that are wide enough to allow your toes to move when you are standing. This often relieves most of the pain. You may also try protective pads to cushion the painful area. Bunion straps or braces are not very useful because they cannot be used with shoes.  A toe spacer, however, placed between the first and second toes, is often helpful to decrease pain.

If your bunion has progressed to the point where you have difficulty walking, or experience pain despite accomodative shoes, you may need surgery. Bunion surgery realigns bone, ligaments and  tendons so your big toe can be brought back to its correct position. Orthopaedic surgeons have several techniques to ease your pain. Many bunion surgeries are done on a same-day basis (no hospital stay) using an ankle-block anesthesia. A long recovery is common and may include persistent swelling and stiffness.