A bunion is a structural deformity where the big toe leans toward the smaller toes and the joint protrudes on the inner side. Footwear changes and padding control symptoms but do not straighten the toe. Surgery is offered when a painful bunion significantly affects daily life, not for appearance alone.
Symptoms
- Pain over the inner bump
- Difficulty fitting into shoes
- Joint pain with activity
- Sometimes pain under the lesser toes as load shifts
- Appearance alone is not a reason for surgery
Causes & risk factors
- Genetics — usually the maternal line — is the biggest factor
- A hypermobile first joint and certain foot shapes
- Far more common in women
- Footwear aggravates but does not cause it in isolation
- Rheumatoid arthritis is an important secondary cause
Conservative treatment comes first
- Wide, rounded-toe footwear (the first and most effective step)
- Toe spacers for comfort
- Custom orthotics, which may slow progression
- An occasional steroid injection into an inflamed bursa for flares
- Surgery is never offered prophylactically or for cosmetic reasons
When surgery is considered
The procedure is matched to the deformity: a scarf osteotomy for moderate–severe bunions, a Lapidus fusion of the first TMT joint where there is significant instability, and an Akin osteotomy for residual toe rotation. Mostly day-case under regional anaesthesia — normal footwear at 6–10 weeks, sport at 4–6 months.
Questions & answers
Recurrence is low when the right procedure is chosen and you stick to sensible footwear afterwards.
It is possible, but most surgeons prefer to stage them a few months apart for an easier recovery.
No. We do not operate on a comfortable bunion for appearance alone, given the recovery and risks involved.
Sources & further reading
- NHS — Bunions
- OrthoInfo (AAOS) — Bunions
- OrthoInfo — Bunion Surgery
