Bunion (hallux valgus)
A bony deformity at the base of the big toe where the big toe deviates outwards and a bony bump develops on the inside of the foot. Hallux valgus is progressive and can become painful as it advances.
📊 Bunions affect approximately 23% of adults aged 18-65 and up to 36% of those over 65. They are around 3 times more common in women than men, and tend to run in families.
What is a bunion?
A bunion - medically known as hallux valgus - is a deformity of the first metatarsophalangeal (MTP) joint, the joint at the base of the big toe. In normal anatomy, the first metatarsal bone is straight, and the big toe points forwards. In hallux valgus, the first metatarsal drifts inwards (medially) and the big toe drifts outwards (laterally) towards the second toe. This combination creates the characteristic bony bump on the inside of the foot.
Bunions develop gradually over years and tend to worsen with time. The deformity is not just a bone problem - the soft tissues around the joint also change, with the tendons that move the big toe pulling it further out of line, the medial joint capsule stretching, and a fluid-filled sac (bursa) often forming over the prominence. Once established, bunions do not reverse, although the rate of progression varies considerably.
Many people have bunions without significant pain, and the deformity itself does not require treatment. Treatment is recommended when there is pain, difficulty with footwear, or when the deformity causes secondary problems such as overlapping toes, calluses, or arthritis of the joint. Surgery is the only way to correct the underlying bony alignment, but it is reserved for patients with symptoms.
Common causes
- Genetic predisposition (the strongest single factor)
- Female sex - women are 3 times more affected than men
- Wearing narrow, pointed, or high-heeled shoes (a contributing rather than sole cause)
- Inflammatory arthritis - especially rheumatoid arthritis
- Hypermobile joints or generalised ligamentous laxity
- Flat foot (pes planus) altering foot mechanics
- Previous foot trauma or surgery
Who is at risk? Family history is the strongest risk factor - around 70% of patients with bunions have an affected first-degree relative. Other factors include female sex, age, footwear choice, flat feet, hypermobility, and rheumatoid arthritis. Bunions in adolescents (juvenile hallux valgus) tend to be more strongly genetic and may progress through skeletal maturity.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- A visible bony bump on the inside of the foot at the base of the big toe
- Pain over the bump, particularly with footwear
- Swelling, redness, or warmth over the joint
- Restricted movement of the big toe
- Skin thickening (callus) over the bump or under the ball of the foot
- Overlapping or crowded toes, with the big toe pushing under or over the second toe
- Difficulty finding comfortable shoes
When to seek help: See a foot specialist if your bunion is painful despite well-fitting footwear, if it is progressing rapidly, if it interferes with daily activities or sport, if you develop secondary problems such as toe deformities or persistent skin breakdown, or if you have rheumatoid arthritis with foot involvement.
How is it diagnosed?
Your foot and ankle specialist will take a detailed history and examine the foot. The following investigations may be arranged to confirm the diagnosis:
- Clinical examination - assessment of deformity, range of movement, and any secondary problems
- Weight-bearing X-rays - the standard imaging, measuring the hallux valgus angle (HVA) and intermetatarsal angle (IMA)
- Mild bunion (HVA 15-25°, IMA 9-13°); moderate (HVA 25-40°, IMA 13-20°); severe (HVA greater than 40°, IMA greater than 20°)
- Assessment for joint arthritis (hallux rigidus) - which significantly changes surgical planning
The severity of the X-ray deformity does not always correlate with the severity of symptoms. Surgical decision-making is based on a combination of symptoms, functional limitation, and X-ray measurements. There are over 100 described surgical techniques, and the choice depends on the angles measured and the presence of arthritis.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Footwear modification
Wearing wide, deep, soft shoes with a roomy toe box reduces pressure on the bunion. Avoiding high heels, narrow shoes, and pointed-toe shoes is essential. This does not correct the deformity but significantly reduces pain in most patients.
Orthotics and bunion pads
Cushioning over the bunion, toe spacers between the big toe and second toe, and orthotics to support the arch can all reduce symptoms. Bunion splints do not correct the bony deformity in adults but may give some symptomatic relief.
Analgesia and activity modification
Simple painkillers, anti-inflammatory medication, and avoiding activities that aggravate symptoms. Local steroid injection can be considered for an inflamed bursa over the bunion.
Distal metatarsal osteotomy (Chevron or scarf)
For mild to moderate deformities, a cut is made in the lower end of the first metatarsal and the bone is realigned and held with screws. The Chevron procedure (V-shaped cut) and scarf procedure (Z-shaped cut) are the most commonly performed. Day case surgery in most patients.
Proximal osteotomy or Lapidus procedure
For severe deformities (IMA greater than 20°) or those with first tarsometatarsal joint hypermobility, the realignment is performed at the base of the first metatarsal or at the joint above. The Lapidus procedure fuses the tarsometatarsal joint to provide a stable, durable correction.
First MTP joint fusion (arthrodesis)
When the bunion is associated with significant arthritis of the joint, joint fusion is preferred. The toe is permanently stiffened in a functional position, eliminating pain. Recovery takes 3-6 months but results are durable.
Recovery
After bunion surgery, you will wear a stiff post-operative shoe for around 6 weeks to protect the bony cut while it heals. Weight-bearing through the heel is usually allowed immediately. Swelling can persist for 6 months or more and is often the slowest aspect of recovery. Returning to fashion footwear may take 6-12 months, and sport-specific activity is typically resumed around 4-6 months.
- Recovery in heel-weight-bearing shoe: 6-8 weeks
- Return to normal shoes: 8-12 weeks
- Return to high-impact activity: 4-6 months
- Final outcome assessment: 12 months
What results can I expect?
Patient satisfaction after bunion surgery is around 85-90% when surgery is performed for appropriate indications. Recurrence rates are around 10-15% over 10 years, higher in younger patients and those with severe deformity. Stiffness at the great toe joint is the most common ongoing issue. Surgery should not be performed purely for cosmetic reasons.
In numbers
When can I…?
Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Drive | 6-8 weeks after surgery | After right-foot bunion surgery, when you can perform an emergency stop comfortably. Inform your insurer.[3] |
| Bear weight in a boot | From day 1 after most surgeries | A heel-weight-bearing shoe or post-op boot is used for the first 4-6 weeks after most bunion operations.[2] |
| Return to normal shoes | 6-12 weeks | Wider, supportive trainers first; narrower shoes and heels much later. Swelling may take several months to settle.[2] |
| Sedentary work | 1-2 weeks | Office work with the foot up is usually possible early. Plan to elevate the foot for most of the day initially.[2] |
| Standing work | 6-8 weeks | Jobs that involve prolonged standing usually need 6-8 weeks off.[2] |
| Light exercise | 6-8 weeks | Stationary cycling and swimming are usually possible from around 6 weeks. Impact sports later.[2] |
| Return to sport | 3-4 months | Impact sports including running and racket sports usually wait until 3-4 months when the bone has fully healed.[2] |
Is this normal?
Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.
Preparing for surgery?
Read our step-by-step guide: what to expect before, during, and after your procedure.
Related conditions
Your questions, answered
Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.
About thisWill my bunion keep getting worse?
Bunions tend to progress slowly over years, though the speed varies a lot and some change very little. Not every bunion needs treatment.
The right approach is to treat symptoms such as pain and rubbing, rather than how the foot looks.
Your choiceCan splints or toe spacers straighten it?
In adults, wide footwear, toe spacers and insoles can ease symptoms, but they do not correct the deformity. The bone position only changes with surgery.
Splints are still worth trying for comfort, just with realistic expectations.
Your choiceShould I have surgery?
Surgery is for bunions that cause pain or difficulty with footwear and daily life despite sensible shoe changes. It is not recommended for cosmetic reasons alone.
It is effective but recovery is long, so it is a considered decision rather than a quick fix.
Getting backWhat is recovery like after bunion surgery?
The bone is realigned and held while it heals, usually with a special shoe or boot for some weeks and weight-bearing as advised.
Swelling in the foot is normal and can take six to twelve months to fully settle.
Pain & sleepWhat helps day to day?
Wide, soft, low-heeled shoes with a deep toe box, bunion pads to reduce rubbing, off-the-shelf or custom insoles, and simple pain relief all help.
Avoiding narrow or pointed shoes makes a real difference to comfort.
Your choiceCan a bunion come back after surgery?
Recurrence is possible, more so with larger deformities, and footwear habits matter afterwards too.
Your surgeon will choose the technique to give the most durable correction for your foot.
UrgentWhen is big toe pain not just the bunion?
A sudden hot, red, intensely painful big toe joint can be gout or infection rather than the bunion itself.
If this happens, especially with feeling unwell or a temperature, get it reviewed.
References & further reading
- 1.NHS: Bunions
- 2.British Orthopaedic Foot & Ankle Society: Hallux valgus (bunion) patient information
- 3.Royal College of Surgeons of England: Driving after surgery guidance
References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.