Bunions: Causes, Shoe Changes and When Foot Pain Needs a Visit

What it involves

MedlinePlus describes a bunion as the result of the big toe pointing outward toward the second toe, which pushes a bump out along the inside edge of the foot. The medical name it gives is hallux valgus, and it says the problem can run in families.

Who this is for

• Patients with a bony bump at the base of the big toe that is red, sore or getting larger
• Patients who struggle to find shoes that fit without pressure on the toe joint
• Patients with diabetes who notice a sore, red or swollen spot on the foot
• Patients whose foot pain keeps them from walking, working or exercising the way they want to

What to expect

• Questions about when the bump appeared, what shoes you wear and which activities make the pain worse
• A look at the foot and toe, because MedlinePlus says a provider can very often diagnose a bunion just by looking at it
• A talk about shoe changes and padding you can try, and whether an x-ray or a referral to a foot specialist makes sense
• A plan for follow-up if the pain continues after self-care

What a bunion looks and feels like

MedlinePlus lists the signs as red, thickened skin along the inside edge at the base of the big toe, a bony bump at the first toe joint with less movement in the toe, and pain over the joint that gets worse with pressure from shoes. In some people the big toe leans far enough that it crosses over the second toe, and corns and calluses then tend to form where the two toes overlap. Many people first notice only that ordinary shoes have stopped fitting comfortably.

Why bunions form

The medical encyclopedia says bunions are more common in women than men, and that the tendency can be inherited, including a difference in how the foot bones line up from birth. It also says that narrow-toed, high-heeled shoes may contribute to a bunion forming. As the bump gets larger, extra bone and a fluid-filled sac can build up at the base of the toe, which is part of why the joint gets more tender over time. Shoes do not explain every case, so a bunion is not a sign you did something wrong.

Self-care that MedlinePlus suggests first

When a bunion is just starting, MedlinePlus advises wide-toed shoes, which it says can often solve the problem and may prevent the need for more treatment. It also suggests felt or foam pads over the bump, spacers to separate the first and second toes, and calf stretches for better alignment of the feet. It mentions asking a provider whether inserts would help if flat feet are part of the picture. The heel pain guide covers another common foot complaint that shoes and arch support can change.

When surgery comes up

If a bunion keeps getting worse and more painful despite self-care, MedlinePlus says surgery may help. The operation, called a bunionectomy, realigns the toe and removes the bony bump, and it notes that there are more than 100 different surgeries for the problem, so the choice belongs in a conversation with a surgeon. MedlinePlus is also candid that surgery reduces pain for many but not all people, and that afterward you may not be able to wear tight or fashionable shoes. Surgery is a referral, not something this practice performs.

Signs that mean a visit sooner

MedlinePlus says to contact a provider if the bunion keeps hurting after self-care such as wide-toed shoes, stops you from doing your usual activities, keeps you from finding a shoe that fits, or causes stiffness and loss of movement in the big toe. It singles out signs of infection, such as redness or swelling, especially in people who have diabetes. If you have diabetes and a foot sore, the diabetic foot care guide explains why even small foot problems deserve prompt attention.

Foot pain that is not a bunion

Not every sore forefoot is a bunion. Corns and calluses, which MedlinePlus says often form where crowded toes overlap, are described in the calluses and corns guide. Pain in the big toe joint that is red, hot and sudden can have a different cause, which the gout guide explains. A provider sorts these apart by looking at the foot, asking about onset and, when the exam leaves a question, considering an x-ray, which MedlinePlus says can show the angle of the toe and any arthritis in the joint.

Sources

• MedlinePlus — Bunions