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Bunions are a deformity of the foot characterised by deviation outwards of the big toe and depending on the severity, a lump over the inside of the big toe joint.



No-one really understands why bunions develop but we do know that 66% are genetic and that inappropriate footwear will make them worse.


Bunions are common, approximately 23% of people 18-65 and 36% of over 65s suffer from bunions the majority of which are women to a ratio of 3 : 1.  Some arthritic conditions, such as rheumatoid arthritis will make bunions worse.


Bunions vary from mild to severe, many people manage their bunions very well with suitable footwear but some people need treatment and a small portion of those will require surgery.


Surgery is only usually considered as a last resort when all other treatments have failed.  It is however, the only way to correct a bunion permanently.  In the early developmental stages of the deformity exercises, pads, splints and orthotics (specialised insoles) can be considered.


To a certain degree it is possible to predict who will develop bunions.  If a child has an intermetatarsal angle (the 'V' shaped angle between the big toe and second toes' metatarsals) is greater thatn 15 degrees then this will result in loss of congruence and thickening of the joint capsule leading to development of a bunion.




In a fully developed bunion, exercise is of little use, but in the early stages within the growing foot there is some evidence that strengthening exercises can help.  This takes time and diligence but in a willing patient results can be good.  Our podiatrist can advise you on these exercises.




Pharmacies sell a variety of protection pads for bunions such as tubular foam, silicone and felt.  These are designed to relieve pressure from footwear over the bunion prominence.


Toe spacers


You can find a selection of wedges to put between your big toe and second toe – these don’t straighten your toe but can relieve pain in the joint and prevent rubbing of the toes.  If you find them uncomfortable, our podiatrist can make a custom made one for you.




There are walking day splints and night splints.  These are designed to put gentle traction on the big toe joint.  Their success is limited in terms of straightening the toe but they can be useful for relieving pain in the joint and have been demonstrated to halt progression of the bunionn.  You can buy these on-line or from your podiatrist.




Orthotics can be useful to correct any lower limb postural alignment problems and for removing stress on the soft tissues and joints.  In some cases they can prevent the bunion from getting worse.  Our podiatrist will evaluate the lower limb and conduct a static and dynamic analysis.  At betterNOW! we have RSScan computerised footscanning equipment that measures time/force through your foot and helps us to diagnose abnormal pressures and movement in the feet.  From this information we can make highly prescriptive orthotics for our clients.




Some bunions can be extremely painful and unsightly and cause real quality of life issues.  Less than 50% of bunions need surgery and this surgery needs to considered carefully.  Bunion surgery will definitely improve the appearance of the foot but it will also alter its function.  Below are there key points a surgeon will take into account:


  • Have you exhausted all options?
  • How much pain are you in
  • What are your motives for bunion surgery
  • Your age
  • Your medical history
  • Your occupation and lifestyle
  • Your expectations of the outcome of the surgery
  • Severity of your symptoms


When is surgery necessary?  When the second toe starts to 'piggyback' over the big toe of is neighbouring toes start to spread apart in a 'Spock' sign -  then it is probably time to get surgery done.  These deformities are as a result of crowding and capsulitis which is painful and damaging.


Leading surgeon, Tim Kilmartin, recommends that if your bunion is not painful, do not have surgery because it is likely that you will not be entirely satisfied post operatively.  Satisfaction rates are higher in severe bunions.  He has published his results as being 88% completely satisfied, 8% bunions recurred, 14% could not wear heels anymore, 86% did not have footwear restrictions.  Theses statistics were based on 53 patients, average age 57 yrs and a follow-up of 9.4 yrs.  Bear in mind this is only one surgeons results and others may vary.


Bunion correction is not to be undertaken lightly, although techniques have improved dramatically, you will have some pain and swelling for up to 3 months post surgery and most patients agree that it is a full year before the foot feel completely ‘settled’.


The most popular bunion surgery currently (not suitable for all patients especially those with arthritis) is the Scarf Osteotomy.  This involves a ‘z’-shaped slice through the length of the 1st metatarsal and repositioning of the big toe (Akins procedure).  The bone is then usually fixed back together with screws.  This is the favoured operation because the length of the bone is not altered which means its level function is left intact without excessive transference pressure to the neighbouring structures.


scarfscarf xray


Pros and benefits:


  • Improved shoe fit
  • Relief of pain from prominent joint
  • Improved cosmetic appearance


Cons and risks:


  • Exposure to anaesthetic
  • Risk of infection
  • Risk of failure
  • Permanent scarring
  • Transference pressure pain and callus
  • Disruption to everyday life in recovery period
  • The bunion may come back or worse the big toe goes the other way (hallux varus)
  • Stiffness of big toe


What makes outcomes worse?


  • Poor patient post operative compliance
  • Poor positioning of the 2nd toe (it must be parallel to the big toe)
  • The sesamoid bones (2 little bones that sit under the big toe joint) are not correctly positioned
  • When the metatarsal is set in an elevated position


Post operatively


Patients do better post operatively if they build up their flexor tendons.  Consult your podiatrist for some special theraband exercises.


Updated: 24 May 2014


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