Bunion

A bunion, or hallux valgus, is a bony bump that forms at the metatarsophalangeal joint at the base of the big toe. It results from misalignment of the big toe toward the second toe and lateral deviation of the first metatarsal. The bump consists of bone and soft tissue changes; the joint may become enlarged and inflamed.

Bunions develop gradually from structural foot problems and are commonly worsened by footwear that crowds the toes or high heels. Risk factors include a family tendency for foot deformities, inflammatory arthritis such as rheumatoid arthritis, prior foot injuries, age, and being female.

Symptoms include a visible bump at the base of the big toe, pain and tenderness, swelling, redness, calluses where the toes rub, and restricted movement of the big toe. Some people have compatible symptoms only when wearing constrictive shoes.

Diagnosis is based on a medical history and exam, with X-rays used to assess deformity and measure angles such as the hallux valgus angle and the intermetatarsal angle.

Treatment begins with non-surgical measures: wider footwear, padding, toe spacers or splints, orthotics, anti-inflammatory medications, icing, and activity modification. Surgery may be considered for persistent pain or severe deformity and usually involves realigning bones (bunionectomy with an osteotomy). Recovery varies.

Prognosis varies; bunions may progress if untreated but many people achieve relief of pain and improved function with appropriate treatment. Not all bunions require surgery.