Bunions (hallux valgus)

Symptoms of bunions can include:

• A large prominence over the great toe which sticks out and rubs on footwear
• Your big toe pointing towards your other toes
• Hard, red or swollen skin over the lump

You may also have pain along the side or bottom of your feet. This is usually worse when wearing shoes and walking.

• Gout: redness, heat, swelling and pain that comes and goes
• Arthritis: aching, swollen and stiff joints; usually worse in the morning

Hard wearing, wide fitting and accommodating footwear may ease symptoms of pain and discomfort. Ideally, it is best to get footwear advice from a person qualified to diagnose and treat foot disorders, such as an orthotist or podiatrist. However, several high street shoe shops can provide good advice about footwear choice. Many patients have found that certain makes of shoes are ‘kinder’ to their bunion, such as Fitflops, Skechers and Ecco.

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DO

• wear wide shoes with a low heels and soft liners or inserts
• consider a firm ‘rocker bottom’ sole
• try a trainer type shoe made with softer materials
• look at using an off-the-shelf insert or orthotic insoles available from many high street providers
• bunion pads (soft pads you put in shoes to stop them rubbing on a bunion) – you can buy these from pharmacies
• take paracetamol or ibuprofen when required
• if you are overweight try to lose weight as this can significantly reduce the load over the painful joint
• topical anti-inflammatory creams that you can rub into the joint can help reduce discomfort

DON’T

• wear high heels or tight, pointed shoes
• wear thin-soled shoes with no support

Painkillers such as paracetamol or ibuprofen may ease any pain, however these should not be taken continuously for prolonged periods of time. Topical anti-inflammatory creams can help reduce pain. Consider discussing pain relief options with your pharmacist, particularly if you are already taking prescribed medications or have any underlying health issues.

Consider consulting a GP if:

• despite footwear and lifestyle modifications, the symptoms persist for more than 6 months
• the pain is stopping you doing normal daily activities eg. at work, or as a carer
• you also have diabetes – foot problems can be more serious if you have diabetes
• there is crossing-over of the toes

Your GP may suggest referral to a foot specialist such as a podiatrist or orthotist in a community assessment service. You could also pay to see a podiatrist or orthotist independently. Click on the icon below to find services local to you.

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A GP or podiatrist can further advise you about:

• things you can do to ease your symptoms, such as wearing wide shoes that do not squash your toes
• things that are available for you to buy or have specially made to reduce bunion pain, such insoles (orthotics), toe spacers and toe supports (splints)
• whether the deformity and symptoms warrant onward assessment or treatment

A GP may refer you to a community assessment service if your bunions are very painful or having a big effect your life. Surgery under the NHS isn’t available just to improve how your feet look, it is to help reduce significant life-limiting pain and discomfort.

Surgery will only be advised for you if you have tried all other methods of treatment but have not had relief for your bunion pain. An operation is usually but not always successful at easing symptoms. You specialist will be able to go through the pros and cons of surgery, and the success rate of the different operations.

What happens during bunion surgery?

The main operation for bunions is an osteotomy.

This involves:

• Making a longish cut in the skin over your big toe
• Cutting away the bunion
• Straightening your toe bone
• Fixing your toe bone in place with metal screws and a staple put under your skin – these are often left in permanently.

Surgery is done under spinal anaesthetic or general anaesthetic. Most people go home the same day.

After surgery

It can take a while to recover from surgery. You will usually need to:

• stay off your feet as much as possible for at least 2-6 weeks
• avoid driving for 6 to 8 weeks
• stay off work for 6 to 8 weeks
• avoid sports for up to 3-6 months

After the operation: your toes might be weaker or stiffer than before and they may not be perfectly straight. Your feet might still be slightly wide, so you will have to keep wearing wide, comfortable shoes.

Bunions sometimes come back after surgery.