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Bunions form when the foot buckles under repeated stress. The bone on the inside of the foot spreads sideways and pushes the toe joint outwards, forming a bunion. Fortunately, there are ways to prevent bunions, and if they have already started to form, keep them from getting worse.
What is a bunion?
A bunion is a hard, bony lump that forms on the inside of the foot at the big toe joint. Although a bunion appears like extra bony growth, it is actually a progressive foot deformity in which the bone connected to the big toe spreads away from the other foot bones. Considered the most common deformity of the foot, bunions affect about 13% of adult men and 30% of adult women.
The first metatarsal is the bone that joins to the big toe. It feels like a hard bony ridge when you run your hand backward along the top of your foot from the big toe joint. That bone is held in place by muscles and ligaments. For a variety of reasons, these muscles and ligaments can fall out of balance and become too tight or too loose. This imbalance eventually pushes the first metatarsal sideways away from the other bones in the foot.
As the metatarsal bone spreads outward, the big toe joint (metatarsophalangeal joint), which is normally straight, bends at an angle. The metatarsal bone protrudes out the inside of the foot as a bony lump. The big toe angles inward towards the second toe. As the metatarsal spreads further, the angle of the toe joint becomes greater.
Bunions are not genetic, but foot type is. Some people are more prone to bunions than others, especially women and people with flat or fallen arches.
Walking or running style contributes substantially to bunion formation. Walking on the insides of the feet—called overpronation—puts more stress and pressure on the big toe and the first metatarsal. Tight shoes and high heels are the single greatest risk factor for bunion formation. They increase stress on the big toe and first metatarsal as well as encourage overpronation. Other bunion risk factors include working in professions that involve long periods of standing, uneven legs, pregnancy, arthritis, and connective tissue disorders.
Also called hallux valgus, a bunion is a progressive foot deformity that worsens without care. Early-stage bunions with only a small big toe joint angle are usually painless. As the MTP joint angle increases, the joint and the foot can start to hurt. The skin covering the bunion and between the big and second toes can start to chafe, blister, redden, swell, or harden. Small sacs of fluid, called bursa, around the joint can swell up painfully, a condition called bursitis.
Severe bunions can be extremely painful and substantially impair daily life. Left untreated, bunions can lead to complications such as osteoarthritis, nerve damage, walking problems, and loss of the big toe’s mobility.
Though less common than big toe bunions, the little toe joint can also develop a bunion. Called a bunionette or tailor’s bunion, the problem is very similar to a big toe bunion. Ligament and muscle problems cause the outer metatarsal to bend outwards. Like a big toe bunion, the little toe joint bends at an angle, forming a lump at the toe joint and forcing the pinkie toe to point inwards.
While bunions are a progressive condition, the prognosis is excellent. People with small toe joint angles can successfully manage discomfort and prevent the bunion from getting worse through conservative treatments. For more severe cases, surgery has an excellent track record at correcting the problem.
How is a bunion diagnosed?
Bunions are diagnosed through a physical examination of the foot by a general practitioner, orthopedist, or podiatrist (foot doctor).
The most obvious symptom of a bunion is a visible bulging “bump” at the big toe joint and the big toe sitting at an angle pointing away from the toe joint. Other common symptoms of bunions include:
- Swelling or redness around the big toe joint
- Pain at the big toe joint that often gets worse when walking
- Blisters, corns, calluses, and irritated skin around the big toe joint
- Limited big toe movement
While a bunion is relatively easy to identify, the doctor will examine the foot carefully for possible causes. An X-ray of the foot will verify the diagnosis, but a doctor may ask for an MRI if other problems are suspected. Blood and urine tests will not be needed unless the doctor believes an underlying metabolic or systemic problem may be causing the problem.
Bunion treatment options
In all but the most severe cases, bunion treatment will start with conservative treatments designed to manage discomfort and prevent the bunion from getting worse. However, only surgery can correct the problem, but it is used only when conservative treatment does not work.
Conservative treatment
Conservative bunion treatment consists of:
- Wearing roomy shoes with flat heels, deep toe boxes, and adequate arch support
- Shoe inserts (orthotics) for arch support or other foot issues
- Bunion pads, cushions, guards, or toe separators to prevent chafing, calluses, and blisters
- Toe stretching to increase range of motion and relieve pain
- Icing the bunion to control pain and discomfort
Medications
Along with shoe modification, orthotics, and other conservative treatments, over-the-counter pain relievers should be sufficient to manage bunion pain. Patients with bursitis will be advised to take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to reduce swelling, but a doctor may use a cortisone injection to relieve severe swelling of the joint’s soft tissues.
Surgery
Bunions can only be corrected through surgery. The success rate is very high, though, but recovery may take a few months. There are over 150 surgical procedures for bunions, but an orthopedic surgeon or podiatrist will select the procedure most suited to a patient’s situation. All of these surgeries can be grouped under five major categories:
- Osteotomy The surgeon removes parts of the metatarsal, the long foot bone right before the big toe, and straightens out the toe joint with pins and plates.
- Lapidus bunionectomy In the Lapidus bunionectomy (or Lapidus procedure), the surgeon fixes the bunion deformity at the back of the metatarsal near the middle of the foot. A part of the first metatarsal is cut out and the bone is fixed with plates and screws to the bone behind it.
- Arthroplasty The surgeon removes part or all of the big toe joint and replaces it with a prosthesis. The procedure maintains joint mobility but reduces the “push-off” power of the big toe.
- Arthrodesis Also called big toe fusion, the surgeon completely removes the big toe joint. As the bones heal, the big toe bone fuses to the metatarsal. While the surgery corrects the bunion, it does so by removing all ability to move the big toe. For this reason, arthrodesis is reserved only for the most severe cases or older patients.
- Soft tissue surgery Bunions are caused by muscle and ligament problems in the foot. A surgeon can correct overly tight or overly loose ligaments and muscles to restore the foot’s proper mechanics. Soft tissue surgery is usually performed along with other corrective surgeries such as an osteotomy or arthroplasty.
- Exostectomy The surgeon cuts away the protruding part of the metatarsal at the big toe joint without fixing the toe angle. Because it does not correct the deformity, it is often performed along with an osteotomy, soft tissue surgery, or both.
After surgery, most patients feel better in a few weeks. However, full recovery from bunion surgery may take as long as four to six months depending on the type of surgery. Many bunion surgeries require that no weight be put on the foot for several weeks. Physical therapy, activity restrictions (including driving), and shoe modification may be required until the foot is fully recovered.
Bunion medications
Bunions can only be fixed surgically, but over-the-counter pain relievers can help manage pain and discomfort.
Pain relievers
Over-the-counter pain relievers along with shoe modification and other conservative treatments are usually sufficient to control bunion pain and discomfort for mild bunions. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen not only relieve pain but also reduce any swelling in the foot’s soft tissues. For patients unable to take NSAIDs, acetaminophen effectively relieves bunion pain but does not reduce soft tissue swelling.
Corticosteroids
In rare cases, an orthopedist or podiatrist may inject a corticosteroid such as methylprednisolone or dexamethasone to relieve bunion complications such as bursitis or arthritis.
What is the best medication for bunions?
Medications can only relieve bunion pain, but they do not treat the bunion. Because people respond differently to different types of pain relievers, there is no “best” medication for bunions.
| Best medications for Bunions | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Advil (ibuprofen) | NSAID | Oral | One 200 mg tablet every four to six hours with food and a full glass of water | Nausea, stomach pain |
| Aleve (naproxen) | NSAID | Oral | One 220 mg tablet taken with food and a full glass of water every eight to 12 hours | Nausea, bleeding, stomach pain |
| Aspirin | NSAID | Oral | One or two 325 mg caplets or tablets with food and a full glass of water every four hours | Upset stomach, heartburn, bleeding |
| Tylenol (acetaminophen) | Analgesic | Oral | Two tablets every four hours | Nausea, stomach pain, loss of appetite |
| Dexamethasone | Corticosteroid | Injection | Varies by specific product/concentration | Cartilage or nerve damage, infection, weak/ruptured tendon, skin discoloration |
| Depo-Medrol (methylprednisolone acetate) | Corticosteroid | Injection | Varies by specific product/concentration | Cartilage or nerve damage, infection, weak/ruptured tendon, skin discoloration |
any of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of bunion medication?
Side effects are possible with all pain relief medications. However, different pain relievers have different side effects, so this is not a complete list of side effects.
Over-the-counter pain relievers are both safe and effective. NSAIDs such as ibuprofen or aspirin most commonly cause side effects that are GI-related, such as nausea, vomiting, indigestion, diarrhea, and stomach pain.
NSAIDs can also potentially cause gastritis, stomach ulcers, bleeding problems, and bruising. In addition to bleeding risk, NSAIDs also come with a warning that they may cause cardiovascular events such as stroke or heart attack.
Acetaminophen does not affect blood clotting or damage the stomach lining but can cause nausea, headache, or stomach pain. Acetaminophen poisoning due to overdose is the most common serious side effect, so always take acetaminophen as directed. Ask your healthcare provider what dose is appropriate for you.
Corticosteroids are not used to treat bunions but instead used to relieve bursitis or other soft tissue complications of bunions. While corticosteroids commonly produce side effects, the doses used for toe joint pain are very low, so most patients will experience no or only very mild side effects. The most common are temporary site reactions such as joint pain, swelling, and redness.
What is the best home remedy for a bunion?
Bunions do not go away without surgery. However, home remedies can help relieve pain, restore normal activities, and help prevent the bunion from getting worse.
Change shoes
To reduce bunion pain and prevent the condition from worsening, wear shoes that have low heels, deep toe beds, wide fronts, and good arch support.
Use shoe inserts
Certain conditions such as fallen arches, flat feet, or improper walking styles contribute to bunion pain. Proper shoe inserts can help correct these conditions and relieve stress on the inside of the foot. Ask your podiatrist for advice—you may be able to get by with inserts you can find at your local pharmacy, or you may need special prescription orthotics.
Change socks
For some people, the pain and discomfort of bunions are due to skin chafing. Low-friction socks can help reduce redness, blisters, calluses, and corns. Compression socks are the best, but not everyone can wear them.
Use padding or taping
Bunion pads, bunion guards, and toe spacers also help to relieve pain and skin chafing. They may not work for everyone, though. Taping can help maintain the proper foot position when walking or standing. Bunion splints effectively relieve pain and discomfort while worn, but they do not “correct” or fix bunions as many products claim to do.
Modify activities
Reduce the amount of time standing or walking to reduce stress on the foot. If your job involves long periods of standing, try to fit in regular sitting breaks a few times an hour.
Stretch the toes
Regular toe stretching helps to relieve bunion pain. Try lifting the toes, curling the toes, or press your toes against the wall so that they are stretched up and back. Another good stretch is to gently pull the big toe out away from the second toe.
Ice the bunion
Place ice packs or ice on the bunion for 20 minutes several times a day to reduce pain and any soft tissue swelling.
Use over-the-counter medications
Over-the-counter pain relievers such as ibuprofen, naproxen, or aspirin can dramatically reduce the discomfort and pain of bunions.
Lose weight
Weight puts more pressure and stress on the foot. Losing a few extra pounds can make bunions more bearable.
Frequently asked questions about bunions
How do you get rid of bunions on your feet?
Bunions can only be fixed surgically.
How can I straighten my toes naturally?
Currently, non-surgical treatments do not straighten bunions. There are, however, natural treatments that can relieve pain and slow the progression of bunions. What’s the best natural treatment for bunions? Wear comfortable, roomy shoes with robust arch support.
How can I stop my bunions from getting worse?
While ill-fitting shoes do not cause bunions, they do make them worse. Shoes should fit properly, have low heels, a wide front, and deep toe beds. Arch support is critical to restoring the proper foot mechanics of standing and walking, so arch support inserts may be necessary. Likewise, footwear without arch support such as slippers, flip-flops, and ballet pumps can make bunions worse.
What happens if bunions go untreated?
Bunions are a progressive condition. Untreated, bunions will become more deformed and possibly lead to complications such as bursitis, osteoarthritis of the toe joint, nerve damage, and loss of mobility of the big toe joint.
What is the best treatment for bunions?
The only way to straighten a bunion deformity is through surgery. Even so, most orthopedists and podiatrists recommend starting with conservative treatment to manage bunion pain and prevent progression before resorting to surgery.
What is the latest treatment for bunions?
There are over 150 types of bunion surgery. New surgical procedures are introduced regularly, often accompanied by slick advertising. Some procedures are even marketed under brand names like a car or cell phone. Unfortunately, there are very few scientific studies regarding the comparative effectiveness of bunion surgeries, so it’s difficult and confusing to sort through the hype around the “latest treatments.” No one knows for certain what treatment is best for bunions, so do your homework. Then have a candid and informed discussion with your orthopedist or podiatrist about the treatment that best addresses your particular situation.
Can you correct a bunion?
Bunions can only be corrected with surgery.
Can foot massage help bunions?
Foot massage can help relieve bunion pain but will not help correct the deformity.
Do bunion correctors really work?
Bunion correctors and bunion splints provide pain relief when worn but they do not correct bunions.
Do flip flops cause bunions?
Arch support is vital to maintaining a proper walking style and taking pressure off the inner and middle foot. Flip flops, slippers, and walking barefoot all lack arch support. They probably do not cause bunions, but they do contribute to their formation and will make them worse.
Will a bunion go away by itself?
Bunions do not go away by themselves. The only way to correct the problem is through surgery.
Is walking barefoot good for bunions?
Arch support and proper walking style are critical in managing bunions. Walking barefoot not only denies the foot arch support but encourages overpronation. With each step, the ankle rolls inward. Because of this inward roll, most of each step’s forefoot “push-off” is done by the big toe and second toe. The added strain on the big toe causes more bunion pain and, over time, worsens the deformity.
Related resources for bunions
- 7 Ways to Ease Bunion Pain without Surgery. Cleveland Clinic
- Bunion. Harvard Health Publishing.
- Bunions. OrthoInfo (American Academy of Orthopaedic Surgeons)
- Bunionectomy. Encyclopedia of Surgery
- Hallux Valgus. StatPearls
- What to Do about Bunions. Harvard Health Publishing