A bunion is a bony bump that forms on the joint at the base of your big toe. A bunion forms when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out. The skin over the bunion might be red and sore.

Wearing tight, narrow shoes might cause bunions or might make them worse. Bunions can also develop as a result of an inherited structural defect, stress on your foot or a medical condition, such as arthritis.

Smaller bunions (bunionettes) also can develop on the joint of your little toes.

The signs and symptoms of a bunion include:

  • A bulging bump on the outside of the base of your big toe
  • Swelling, redness or soreness around your big toe joint
  • Thickening of the skin at the base of your big toe
  • Corns or calluses — these often develop where the first and second toes overlap
  • Persistent or intermittent pain
  • Restricted movement of your big toe

When to see a doctor

Although bunions often require no medical treatment, see your doctor or a doctor who specializes in treating foot disorders (podiatrist or orthopedic foot specialist) if you have:

  • Persistent big toe or foot pain
  • A visible bump on your big toe joint
  • Decreased movement of your big toe or foot
  • Difficulty finding shoes that fit properly because of a bunion

Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons in your feet. This imbalance in pressure makes your big toe joint unstable, eventually molding the parts of the joint into a hard knob that juts out beyond the normal shape of your foot.

Experts disagree on whether tight, high-heeled or too-narrow shoes cause bunions or whether footwear simply contributes to bunion development. Other causes include:

  • Inherited foot type
  • Foot injuries
  • Deformities present at birth (congenital)

Bunions may be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis. An occupation that puts extra stress on your feet or one that requires you to wear pointed shoes also can be a cause.

These factors may increase your risk of bunions:

  • High heels. Wearing high heels forces your toes into the front of your shoes, often crowding your toes.
  • Ill-fitting shoes. People who wear shoes that are too tight, too narrow or too pointed are more susceptible to bunions.
  • Arthritis. Pain from arthritis may change the way you walk, making you more susceptible to bunions.
  • Heredity. The tendency to develop bunions may be present because of an inherited structural foot defect.

Although they don't always cause problems, bunions are permanent unless surgically corrected. Possible complications include:

  • Bursitis. This painful condition occurs when the small fluid-filled pads (bursae) that cushion bones, tendons and muscles near your joints become inflamed.
  • Hammertoe. An abnormal bend that occurs in the middle joint of a toe, usually the toe next to your big toe, can cause pain and pressure.
  • Metatarsalgia. This condition causes pain and inflammation in the ball of your foot.

If you're having problems with your feet, you're likely to start by seeing your primary care doctor. Your primary care doctor may refer you to a foot specialist (podiatrist or orthopedic foot specialist).

What you can do

To make the most of your time with your doctor, prepare a list of questions before your visit. Your questions might include:

  • What's causing my foot problems?
  • Is this condition likely to be temporary or permanent?
  • What treatment approach do you recommend?
  • Am I a candidate for surgery? Why or why not?
  • Are there any additional self-care steps that might help?

Don't hesitate to ask any other questions.

What to expect from your doctor

Some questions your doctor might ask of you include:

  • When did you begin having foot problems?
  • How much pain do you have in your foot?
  • Where is the pain?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What type of shoes do you wear?

Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling.

After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.

Treatment options vary depending on the severity of your bunion and the amount of pain it causes.

Conservative treatment

Nonsurgical treatments that may relieve the pain and pressure of a bunion include:

  • Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
  • Padding and taping or splinting. Your doctor can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.
  • Medications. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) can help you control the pain of a bunion. Cortisone injections also can be helpful.
  • Shoe inserts. Padded shoe inserts can help distribute pressure evenly when you move your feet, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people, although others may require prescription orthotic devices.
  • Applying ice. Icing your bunion after you've been on your feet too long can help relieve soreness and inflammation.

Surgical options

If conservative treatment doesn't provide relief from your symptoms, you may need surgery. The goal of bunion surgery is to relieve discomfort by returning your toe to the correct position.

There are a number of surgical procedures for bunions, and no one technique is best for every problem.

Surgical procedures for bunions might involve:

  • Removing the swollen tissue from around your big toe joint
  • Straightening your big toe by removing part of the bone
  • Realigning the long bone between the back part of your foot and your big toe, to straighten out the abnormal angle in your big toe joint
  • Joining the bones of your affected joint permanently

It's possible you may be able to walk on your foot immediately after a bunion procedure. However, full recovery can take weeks to months. To prevent a recurrence, you'll need to wear proper shoes after recovery. It's unlikely that you'll be able to wear narrower shoes after surgery.

Surgery isn't recommended unless a bunion causes you frequent pain or interferes with your daily activities. Talk to your doctor about what you can expect after bunion surgery.

These tips may provide relief from a bunion:

  • Apply a nonmedicated bunion pad to the bony bump.
  • Apply an ice pack two to three times daily to help reduce swelling if a bunion becomes inflamed or painful.
  • Wear shoes with a wide, deep toe box.
  • Avoid shoes with heels higher than 2 1/4 inches (5.7 centimeters).

See your doctor if pain persists.

To help prevent bunions:

  • Be sure your shoes don't cramp or irritate your toes.
  • Choose shoes with a wide toe box — there should be space between the tip of your longest toe and the end of the shoe.
  • Your shoes should conform to the shape of your feet without squeezing or pressing any part of your foot.
  • Avoid pointy-toed shoes.
Feb. 11, 2014