Patient information · Orthopaedics
Bunions
manage the symptoms, or fix the bone — there is no third option
A bunion is a bony prominence where the big toe drifts towards the others and its joint pushes outwards. It is largely inherited rather than caused by shoes, though shoes make it hurt. Nothing non-surgical straightens the toe — but a great deal makes it comfortable.
Seek prompt assessment if you have
- a hot, red, swollen joint with fever — possible infection or gout
- an ulcer or broken skin over the bunion, particularly with diabetes
- sudden severe pain without injury
- numbness, tingling or a pale, cold foot
- rapidly worsening deformity with joint swelling elsewhere, suggesting inflammatory arthritis
Any break in the skin over a bony prominence in someone with diabetes or poor circulation needs same-day assessment. A hot swollen joint may be septic arthritis or gout, not simply a painful bunion.
What causes them
- Inherited foot shape and joint laxity — the dominant factor. Bunions run strongly in families and occur in people who have never worn narrow shoes.
- Footwear — narrow toe boxes and heels do not create the underlying tendency but accelerate it and cause most of the pain.
- Flat feet and excessive pronation, which increase load through the big toe joint.
- Inflammatory arthritis, particularly rheumatoid.
- More common in women, and increasingly common with age.
Splints, spacers and toe straighteners do not correct a bunion
They are widely sold on the premise that they realign the toe. The deformity is in the bone and the joint, and no external device changes that in an adult — trials show no lasting change in the angle. That does not make them useless: spacers and toe sleeves genuinely reduce rubbing and pain for many people, and are worth using for comfort. Just buy them for what they do, not for what the packaging claims.
What genuinely helps
Helps
- Shoes with a wide, deep toe box — measure your foot at its widest point
- Low heels; every centimetre of heel loads the forefoot further
- Bunion pads, toe sleeves or gel spacers for rubbing
- Orthotic insoles where the foot pronates heavily
- Anti-inflammatory gel, and losing excess weight
Not effective
- Night splints and correctors, for straightening
- Exercises to realign the toe, though foot strengthening helps generally
- Waiting until it is unbearable before seeking advice
- Cutting holes in shoes rather than changing them
- Surgery purely for appearance
Surgery
Surgery corrects the bone and is highly effective for pain. It is offered for pain and function, not appearance — operating on a painless bunion to make the foot look better carries real risk for no symptomatic gain, and is generally advised against.
- There are many techniques, chosen according to the severity of the angle and the state of the joint.
- Recovery is longer than most people expect, and swelling of the foot in the evening can persist for a year.
- Recurrence occurs in a proportion of cases, particularly in younger patients and with severe deformity.
- You will not be able to drive for several weeks, and should plan time off work accordingly.
- You may still not fit narrow fashion shoes afterwards — the operation restores a functional foot, not a narrow one.
Why come to us. Most bunions do not need an operation, and knowing which do is the useful part. Our orthopaedic and physiotherapy teams assess the foot, check the joint for arthritis and rule out gout with blood tests taken in-house, advise on footwear and orthotics, and arrange weight-bearing X-ray through our CQC-registered partners when surgery is genuinely being considered. Seven days a week, no referral needed.
Assessed by orthopaedics without a referral
Seven days a week, bloods in-house, imaging arranged fast.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.