A bunion is a change in the shape and alignment of the joint at the base of the big toe. Also known as hallux valgus, it develops as the big toe gradually angles towards the other toes and a prominent bump forms on the inner side of the forefoot.
Bunions can be painless, but they may also cause rubbing, pressure, redness and discomfort when walking or wearing shoes. There is not always one clear reason why a bunion develops, and several factors can contribute over time.
What exactly is a bunion?
A bunion is more than simply a lump growing on the side of the foot. It is associated with a change in the alignment of the big toe joint, known as the first metatarsophalangeal joint.
As hallux valgus develops, the big toe moves towards the smaller toes while the first metatarsal moves in the opposite direction. This makes the inner side of the joint increasingly prominent.
The prominent area may then become irritated by footwear, particularly if shoes are narrow around the forefoot.
Bunion and hallux valgus mean closely related things. Hallux valgus describes the change in alignment of the big toe, while the visible prominence at the joint is commonly referred to as the bunion.
What are the common signs of a bunion?
A prominent big toe joint
A visible bump may develop on the inner side of the foot at the base of the big toe.
Big toe position
The big toe may gradually angle towards the second toe and, in more developed cases, can begin to crowd the neighbouring toes.
Rubbing & pressure
The prominent joint can rub against footwear, causing tenderness, redness, hard skin or irritation.
Pain during activity
Some people experience discomfort around the joint when walking, standing for longer periods or wearing certain shoes.
Why do bunions develop?
There is not always a single identifiable cause. Bunions can develop gradually and are likely to be influenced by a combination of foot structure, joint mechanics, footwear and other individual factors.
Two people can wear similar footwear throughout their lives and have very different feet, which is why it is misleading to say that shoes alone cause every bunion.
| Possible factor | How it may be relevant |
|---|---|
| Foot shape and structure | The natural shape and mechanics of the foot can influence how forces pass through the big toe joint. |
| Family tendency | Bunions can occur in families, although what may be inherited is often the structure or characteristics of the foot rather than the bunion itself. |
| Footwear | Narrow, pointed or poorly fitting shoes can increase pressure around the toes and may aggravate an existing tendency towards hallux valgus. |
| Joint and tissue factors | Differences in joint stability, soft tissues and the way the foot functions can influence alignment over time. |
| Other foot or joint conditions | Some people have underlying conditions that can affect the structure or function of the forefoot. |
Are bunions hereditary?
Bunions often appear in more than one member of a family, but this does not necessarily mean that a bunion itself is directly inherited.
Characteristics such as foot shape, joint structure and the way the foot moves can run in families. These features may make some people more likely to develop hallux valgus over time.
Do tight shoes cause bunions?
Footwear is better thought of as one possible contributing or aggravating factor rather than the only cause.
Shoes with a narrow toe box can crowd the toes and place additional pressure over an already prominent big toe joint. High heels can also move more body weight towards the forefoot.
Choosing footwear with enough width and depth for the toes can reduce pressure and rubbing, even though changing shoes will not remove an established bunion.
Can a bunion get worse over time?
Bunions can gradually become more noticeable, but progression varies considerably between individuals. Some remain relatively stable for long periods while others become increasingly prominent or symptomatic.
Changes can include greater deviation of the big toe, increased pressure against the second toe, more difficulty finding comfortable footwear or increasing irritation around the joint.
It is not possible to predict exactly how quickly an individual bunion will change simply by looking at it once.
Why does a bunion hurt?
The visible prominence can become irritated by pressure and friction from footwear. The joint itself may also become painful, and altered toe alignment can change how pressure is distributed across the forefoot.
Some people mainly notice tenderness directly over the bunion, while others experience discomfort underneath the forefoot or around neighbouring toes.
Why do bunions rub in shoes?
A bunion increases the width of the forefoot around the big toe joint. If the shoe does not provide enough space, the prominent area can press against the upper of the footwear with every step.
This can result in redness, tenderness or areas of hardened skin. Wider footwear and soft bunion protectors or shields can sometimes help reduce this direct friction and pressure.
Can bunions affect the other toes?
As the big toe moves towards the smaller toes, space within the forefoot can become more restricted.
In some people this leads to crowding or pressure between the toes. More developed deformity can also be associated with changes in the position of neighbouring toes.
Is every lump beside the big toe a bunion?
No. Pain and swelling around the big toe joint can have several causes, and not every painful or prominent joint is hallux valgus.
A joint that becomes suddenly very painful, hot, red or markedly swollen should not simply be assumed to be a bunion. If you are unsure what is causing your symptoms, seek professional assessment.
Can you prevent a bunion?
It may not always be possible to prevent a bunion from developing, particularly where foot structure and other individual factors play a role.
However, choosing shoes that fit correctly and provide adequate room around the toes can reduce unnecessary pressure on the forefoot. Avoiding consistently narrow or pointed footwear can also improve comfort where hallux valgus is already present.
Can bunion splints or toe spacers remove a bunion?
Non-surgical supports such as toe spacers, splints, shields and protectors can be useful for managing particular symptoms or supporting toe position while they are being worn.
For example, a soft bunion shield may reduce rubbing from footwear, while a toe spacer can help separate crowded toes. A bunion splint may hold the big toe in a different position during use.
These products should not be presented as a way of permanently removing an established bunion. Their role is generally to improve comfort, reduce pressure or provide support as part of conservative management.
When should you seek professional advice?
Consider seeking advice from a GP, podiatrist or other suitably qualified healthcare professional if bunion pain continues despite changing footwear and trying simple measures, if symptoms are affecting normal daily activity, or if the deformity appears to be progressing significantly.
Professional assessment is also particularly important if you have diabetes and develop foot pain, skin damage or other problems around a bunion.
Living with a bunion
Many people manage bunion symptoms without surgery by concentrating on comfort and reducing avoidable pressure around the joint.
Wide, comfortable footwear is an important starting point. Depending on your symptoms, gel protectors, toe spacers, splints or other foot supports may also be useful.
The most appropriate option depends on whether your main problem is rubbing, toe crowding, joint discomfort or the need for additional support.
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