A bunion is a firm, fluid-filled pad overlying the inside of the joint at the base of the big toe (metatarsophalangeal joint). The pad (bursa), which may get larger and stick out, can become inflamed and painful. Bunions may run in families, but many result from wearing tight shoes. Nine out of 10 bunions are developed by women. Nine out of 10 women wear shoes that are too small. Tight shoes also can cause other disabling foot problems like corns, calluses and hammertoes.
Our approach to bunion
The first-line treatment for bunions is to wear shoes that fit properly and have plenty of toe space. Some patients, however, continue to experience pain and difficulty walking. For these patients, surgical treatment is available. In this procedure, the surgeon realigns the bone, ligaments, tendons and nerves to bring the big toe back to its correct position.
Our team includes highly trained orthopedic surgeons who specialize in the ankle and foot, as well as podiatrists, physical therapists and pedorthists (specialists in modified footwear and supportive devices for the lower leg). Our goals are to relieve pain and restore mobility, so patients can return to their normal lives and the activities they enjoy. We offer doctor's appointments, medical imaging and physical therapy in one convenient location.
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Signs & symptoms
The skin over your big toe may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful. Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. If this condition gets severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis.
A thorough medical history and physical exam by a physician is necessary for the proper diagnosis of bunions and other foot conditions. X-rays can help confirm the diagnosis by showing the bone displacement, joint swelling, and, in some cases, the overgrowth of bone that characterizes bunions. Doctors also will consider the possibility that the joint pain is caused by or complicated by:
- Arthritis, which causes destruction of the cartilage of the joint
- Gout, which causes the accumulation of uric acid crystals in the joint
- Tiny fractures of a bone in the foot or stress fractures
Your doctor may order additional tests to rule out these possibilities.
If your bunion has progressed to the point where you have difficulty walking, or experience pain despite accommodating shoes, you may need surgery. Bunion surgery realigns bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position. Orthopedic surgeons have several techniques to ease your pain. Many bunion surgeries are done on a same-day basis, requiring no hospital stay, using an ankle-block anesthesia. A long recovery is common and may include persistent swelling and stiffness.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.