Bunion

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

A bunion (hallux valgus) is a sometimes painful structural deformity of the bones and the joint between the foot and big toe.

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe (metatarsophalangeal joint). The big toe may turn in toward the second toe (displacement), and the tissues surrounding the joint may be swollen and tender.

Today the term usually is used to refer to the pathological bump on the side of the great toe joint. The bump is the swollen bursal sac and/or an osseous (bony) deformity that has grown on the mesophalangeal joint (where the first metatarsal bone and hallux meet).

The term “hallux valgus” or “hallux abducto valgus” are the most commonly-used medical terms associated with a bunion deformity, where “hallux” refers to the great toe, “valgus” refers to the abnormal rotation of the great toe commonly associated with bunion deformities, and “abducto” refers to the abnormal drifting or inward leaning of the great toe towards the second toe, which is also commonly associated with bunion disorders.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Bunions are caused by a biomechanical abnormality, where certain tendons, ligaments, and supportive structures of the first metatarsal are no longer functioning correctly. This biomechanical abnormality may be caused by a variety of conditions intrinsic to the structure of the foot–such as flat feet, excessive ligamentous flexibility, abnormal bone structure, and certain neurological conditions. These factors are often considered genetic.

Bunions are commonly associated with a deviated position of the big toe toward the second toe; and the deviation in the angle between the first and second metatarsal bones of the foot. The small sesamoid bones found beneath the first metatarsal (which help the flexor tendon bend the big toe downwards) may also become deviated over time as the first metatarsal bone drifts away from its normal position.

Arthritis of the great toe joint, diminished and/or altered range of motion, and discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion development.

Although wearing shoes that crowd the toes does not cause bunions to form, it sometimes makes the existing deformity progressively worsen and symptoms may arise sooner.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The causes of bunions are unclear. Bunions sometimes run in families. Being born with abnormal foot bones may increase likelihood of developing a bunion. Wearing narrow-toed, high-heeled shoes may lead to the development of a bunion.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Bunions occur more commonly in women and can sometimes run in families. People born with abnormal bones in their feet are more likely to form a bunion.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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• Chronic foot pain
• Foot deformity
• Stiff foot
• Hallux varus (occurs with surgical over-correction, where the toe points away from the second toe)

The outlook depends on your age and activities, and the severity of the bunion. Teenagers may have more trouble treating a bunion than adults. Many adults do well by caring for the bunion when it first starts to develop, and wearing different shoes. Surgery reduces the pain in many, but not all, people with bunions.

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