Bunions are a common foot condition and are also known as hallux valgus. In technical terms it is a deformity of the first ray which can cause pain in the big toe joint. Or in layman’s terms it forms when the big toe starts to lean towards the other toes, causing the metatarsal bone to shift outward. Over time, this misalignment creates a prominent bump on the inner edge of the foot. 

Bunions can be hereditary, or they may develop due to repeated pressure and friction on the foot. This can change the way we walk or people may find it difficult to find suitable footwear. Some people get a smaller bunion, known as a bunionette, in the joint of the smallest toe.

Causes of Bunions:

Several factors contribute to the development of bunions, including:

  • Genetics: If bunions run in your family, you may be more prone to developing them.
  • Foot Structure: Certain foot shapes and arch types can increase the risk of bunion formation.
  • Improper Footwear: Wearing tight, narrow, or high-heeled shoes can force the toes into an unnatural position, exacerbating bunion development.
  • Age: Bunions are more common in older adults due to wear and tear on the foot joints over time.

What are the symptoms of bunions?

Many people have bunions without any symptoms and they usually develop slowly over many years. 

Some people may find:

  • The bunion can cause pain while wearing shoes and walking due to pressure on the joint
  • The bunion can change the position of other toes and shape of the feet causing pressure points. These pressure points can also become red, inflamed and calloused (an area of hard, thick skin).
A Podiatrist checking a patient's bunion

How are bunions diagnosed?

If you think you have a bunion, a Podiatrist will diagnose and assess the foot. Imaging such as x-ray may be undertaken to determine the severity and integrity of the joint.

Dependent on pain and whether conservative management of a painful bunion has helped, a Podiatrist may refer you to an orthopedic specialist.

How are bunions treated?

When bunions cause pain or interfere with daily activities, it’s time to explore treatment options. Here are some common methods used to manage bunions:

  • Non-surgical Approaches:
    • Orthotics: Custom orthotic devices can help change the alignment of the foot and reduce bunion discomfort.
    • Padding and Taping: Special pads or tape can relieve pressure on the bunion, reducing pain.
    • Medications: Over-the-counter pain relievers or anti-inflammatory drugs can provide temporary relief.
    • Footwear Modifications: Switching to more suitable shoes can prevent bunion aggravation. Such as wider footwear to allow the toes to spread out and softer leather. Avoid high-heeled shoes as they squeeze your toes together and move your weight forward onto the big toe.
    • Toe spacers:  to help allow the toes to spread
    • Toe exercises: to help strengthen the feet and improve overall foot function. 
  • Surgical Interventions:
    In severe cases where non-surgical treatments prove ineffective, bunion surgery may be necessary. A podiatrist or orthopedic surgeon can determine the most appropriate surgical procedure based on the individual’s condition.

How can bunions be prevented?

To prevent bunions from getting worse, always choose comfortable, wide shoes that fit properly and don’t squeeze your toes together. It is particularly important to ensure you fit children’s feet with appropriate footwear.

What are other causes of big toe pain?

There can be many other types of pain in the big-toe that can be confused for a bunion such as arthritis, gout and bursitis.

Big toe joint arthritis

Arthritis can change the shape of the toe which can resemble a bunion due to swelling within the joint. This can cause hallux rigidus or limitus which causes bone spurs to develop within the joint. This leads to inflammation and irritation of the skin, making the bump resemble a bunion. Whilst the bony prominence is on the side in bunions, bone spurs with arthritis tend to occur above the big toe joint.


Gout occurs when there are high levels of uric acid which develop into internal crystals within the joint. This is a common problem which affects the toes and the feet, with the big toe being the most common site of pain. It causes the joint to become red, swollen and can be mistaken for bunions. The pain is sharp and intense and can decrease mobility. To reduce the pain medication can be issued and also consider a change to the diet.


Bursitis is a common cause of big toe pain and occurs where there is swelling and redness over the joint, often due to direct external pressure. Because the big toe tolerates the entire weight of the body when you walk it is prone to bursitis. It is also more susceptible to irritation from shoes. The bursa is between the bone and skin and this is where the inflammation sits, it can be incredibly painful. To help manage the pain, offloading, changing footwear and potentially anti-inflammatory medication or a cortisone injection is needed.

You should see a Podiatrist if you:

Have pain in the big toe joint

are finding it difficult to wear shoes, walk or do the activities you love.

Early intervention can make a significant difference in managing bunions and maintaining your mobility and comfort in the long run. 

References: Mayo Clinic

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