Bunions (Hallux Valgus)

Hallux valgus, also known as bunions, is a common foot problem in adults, especially women. It affects about one in five adults and can occur in one or both feet, usually worse in one foot. A bunion is a bony lump that forms on the inside of the foot at the big toe joint, causing the big toe to lean towards the second toe.

Many people with bunions don’t feel pain and don’t need treatment, but some do experience pain and deformity. Finding comfortable shoes can be difficult, as bunions make the foot wider and shoes tighter. Tight shoes can cause rubbing, redness, swelling, and even blisters. Sometimes, a small fluid-filled sac called a bursa can form over the bunion, which can become inflamed and painful.

Signs and Symptoms of Bunions:

• Bony lump on the inside of the big toe joint
• Big toe leaning towards the second toe
• Pain, stiffness, and swelling of the big toe joint
• Red, swollen, or hard skin over the bunion
• Difficulty finding comfortable shoes
• Deformity of the smaller toes

Causes of Bunions:

The exact cause of bunions is unknown, but they may run in families, be related to the shape of your feet, or be caused by ill-fitting shoes. Other factors include:

• Previous injuries to the toe joints
• Flexible joints
• Age
• Inflammatory arthritis (like Rheumatoid Arthritis)
• Tight muscles in the back of the leg
• Neuromuscular conditions (like Stroke or Cerebral Palsy)
• Activities that put stress on the big toe joint (like walking or running)

How to help with Bunions:

You can manage bunion pain by reducing pressure on the affected area. These tips won’t change the size or shape of the bunion but can help with discomfort:

• Rest and elevate your foot
• Apply an ice pack (in a towel) to the painful area for up to 20 minutes every 2-3 hours
• Wear shoes with cushioned heels and good arch support
• Use insoles in your shoes
• Do regular stretching and foot exercises
• Try low-impact exercises like swimming
• Lose weight if needed

Things to avoid:

• Walking or standing for long periods
• Wearing high heels and tight, pointy shoes
• Wearing flip-flops or backless slippers
• Walking barefoot on hard surfaces

Choosing the right shoes:

Pick shoes that are wide and deep enough to fit your bunion and any other toe deformities. Softer materials can mould around the bunion better than hard leather. Narrow shoes can rub against the bunion, causing redness, swelling, and blisters.

Managing Pain:

Use a pain scale from 0-10 to identify your pain level. Aim to stay in the mild pain zone by pacing your activities. If you experience severe pain, you might be overdoing it and should reduce your activity level.

Is bunion surgery right for me? 

Living with a bunion can be painful and affect your daily life. Surgery is the only way to get rid of them, but there are things you can do to ease any pain they cause.

Deciding to have surgery is a big step, and it’s normal to have questions and concerns.  

You might need bunion surgery if: 

• Severe Pain: Your bunion causes constant pain that affects your daily life, even after trying other treatments like better shoes.

• Limited Mobility: You have trouble walking or doing activities because of the bunion. 

• Worsening Condition: The bunion is getting worse, affecting your toe alignment and causing more foot problems. 

• Failed Non-Surgical Treatments: Other treatments haven’t worked well enough (footwear, padding). 

• Quality of Life: The bunion makes you uncomfortable and limits your ability to wear certain shoes. 

What to consider before surgery 

Financial Impact

• Time Off Work: Recovery can take weeks to months, and you might not be able to work, especially if your job involves standing or walking. 

• Income Loss: Think about how being off work might affect your income and whether you have sick leave or disability benefits. 

Caring Responsibilities

• Dependents: Plan how to care for children or other dependents during your recovery. You might need help from family or friends. 

• Household Tasks: Daily chores might be hard to manage. Arrange for help with cooking, cleaning, and shopping. 

Physical Considerations 

• Mobility: You’ll have limited mobility, especially in the first few weeks. Using crutches, a knee scooter, or a walker can help, but it takes practice. 

• Home Setup: Make your home recovery-friendly by setting up a comfortable resting area and ensuring easy access to essential items. 

Health and Lifestyle 

• Pre-Surgery Health: Staying healthy before surgery can help you recover faster. Eat a balanced diet, stay hydrated, and exercise regularly. 

• Smoking: If you smoke, quitting can improve healing and reduce complications. 

Emotional and Mental Preparation 

• Support System: Having a strong support system can help you cope with the challenges of recovery. 

• Expectations: Understand the recovery process and set realistic expectations for pain management and mobility improvements. 

More information on bunion surgery can be found here: Bunions

Images and videos reproduced with permission of NHS Lanarkshire.