Bunion FAQs

A bunion is a bony bump that forms on the joint at the base of the big toe. It occurs when the big toe pushes against the next toe, forcing the joint of the big toe to get larger and stick out. This condition is often associated with the misalignment of the bones in the foot, leading to the formation of the bunion.

This is also called hallux valgus deformity. Over time the metatarsal head (bony bump) will tend to drift and become more prominent.

Symptoms of bunions may include pain, swelling, redness, and restricted movement of the big toe. In some cases, bunions may not cause any discomfort, but they can still affect the alignment of the toes and the overall structure of the foot.

Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will tend to also have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.

Bunions can be caused by various factors, including genetics, improper footwear, and certain foot conditions. High-heeled shoes and narrow-toed shoes can contribute to the development or worsening of bunions by squeezing the toes together. The pressure on the joint can lead to inflammation, pain, and the characteristic bony bump.

Most bunion are diagnosed on clinical examination and X-rays.

Your foot has a normal amount of outward angulation at the big toes joint. Less than 15 degrees is considered normal. This is called a Hallux Valgus Angle. 15-30 degrees is considered moderate deformity. More than 30 degrees is considered severe deformity. More than 40 degrees is considered very severe deformity.

We also use a measurement called a intermetatarsal angle. This is also elevated in hallux valgus deformity. Normally it is less than 9 degrees, but it can be elevated in hallux valgus. Treatment options change depending on the severity of your deformity.

Treatment options for a bunions / Hallux Valgus include operative and non operative options. The goal of treatment is to reduce pain, increase mobility, and restore function. We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a difference. This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing. There are low profile braces that can help correct the position of the toes.

These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.

We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a difference. This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing. There are low profile braces that can help correct the position of the toes. These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.

In most cases of hallux valgus / bunions the deformity tends to get worse and worse. This will likely happen over years. As this occurs, your pain will tend to be more frequent and more severe. Non-operative treatment can help in less severe cases of hallux valgus. As the deformity worsens, as symptoms progress, non-operative measures are more likely to fail. Surgery is more likely indicated in severe cases.

The type of surgery done for a bunion depends on several factors. Additionally, there are multiple options for each type / severity deformity. Outcomes for these options are similar, assuming the correct surgery is done for the type of deformity.

For mild deformities, tightening the soft tissues on the inside of the bump, and shaving down the bone, may be adequate.

For moderate deformities, osteotomy (cut and re-align) of the 1 st metatarsal bone or fusion of the first TMT joint are usually indicated. This may be combined with an osteotomy of the proximal phalanx and soft tissue releases depending on severity of the deformity

For very severe deformities fusion procedures are usually indicated. However, osteotomies can be attempted to try and salvage the joint and prevent fusion of the 1 st metatarsal phalangeal joint. This is done with the goals of preserving motion. However, if there is arthritis of the 1 st metatarsal phalangeal joint, a fusion is often indicated.

Speak to one of our surgeons to discuss which surgeries are right for you.

The surgery itself typically takes 1-2h and can be done as an outpatient procedure. You go home the same day in most cases.

Following surgery, you will have a dressing on your incision and a cast on your foot. Ideally the area should remain completely dry until the staples / sutures are removed (2-3 weeks after surgery). We see you at 2 weeks after surgery to remove sutures and change the cast. You may go into a pneumatic boot at this stage.

Surgery is painful. Most of the pain is experienced in the first few days. We give you strong pain medication and a pain management plan to address this. Swelling management is paramount. The foot will swell greatly after foot surgery. Icing and elevation is imperative. After the first week the pain tends to improve rapidly. I anticipate at two weeks the pain is much better. At 6 weeks most the pain should be gone.

Bones take approx. 6 weeks to heal enough that they will tolerate weight bearing. We typically keep you non-weight bearing for 4-6 weeks. Swelling may be present for 6+ months after surgery. Eventually this returns to normal levels.

This depends on the severity of deformity. Most surgeons will trial non operative measures. If these are not helpful for 3-6 months of treatment, surgery is typically indicated. There are several surgical options. As your surgeon which option is best for your specific deformity.

There are several exciting new developments in the world of bunions. Lapiplasty is a new system that uses special guides / jigs to perform a Lapidus procedure (fusion of the 1 st TMT joint), allowing for correction of the deformity. It utilizes some principles from the knee replacement and hip replacement realm, to systematically improve bunion outcomes. May patients report excellent outcomes after this procedure. They utilize fill incision but has
special plating system to help mobilize the patient faster.

Minimally invasive bunion correction is also an exciting development over the last few years. This involves using small burrs to make bone cuts through small incisions. This allows us to keep incision small, and recovery quick. Outcomes from these procedures are excellent. Patients tend to be very happy.

Both of these types of procedures offer excellent outcomes, improved patient satisfaction, and enhanced recovery. Ask our surgeons which procedure is right for you.

Vast majority of patient undergoing bunion surgery report improved pain, better function, more ability to weight bear, better footwear tolerance, and excellent satisfaction with bunion surgery.

When the right surgery is done for the deformity you have, outcomes are great. Ask one of our surgeons if you are a candidate.

See this excellent study by the American Orthopedic Foot and Ankle Society
https://journals.sagepub.com/doi/abs/10.1177/107110070102201205

Over the counter bunion braces can help correct the deformity for a period of time. These braces typically help by countering your foot deformity with an external brace / device. However, in most patients these deformities worsen over time. As a result, these brace stop working as the deformity gets worse.

Over the counter medication can help with pain. But it does not address the underlying mechanical problems with your foot. It may help you function better day to day. Some patients with mild deformity can go on for decades, coping in this fashion.

Orthotics and appropriate footwear can help patients with mild to moderate deformity. This is particularly true if you have high arches or flat feet. Often it helps with daily pain symptoms. Over the years the deformity tends to get worse.

Yes.

Heat can feel good in the moment. However, it tends to increase blood flow and results in
localized swelling as a result. This will typically make pain worse after the heat is removed.
Icing is often more helpful. However, many patients report that heat helps them with their pain.
These is no harm in trying both and seeing what works for you.

Yes. Ice can help reduced swelling and improve pain. We recommend you try this in addition to
elevation, pain medication, and activity modification. This may be sufficient to treat your pain, if
you bunion is mild.