Bunion

A bunion (hallux valgus) is a bony bump that forms at the base of the big toe, where it meets the foot. It happens when the big toe gradually angles towards the second toe, causing the joint to protrude. Bunions can lead to pain, swelling, footwear difficulties and changes in the shape of the forefoot.

Bunions are common and can worsen over time. Many can be managed without surgery, but if symptoms are affecting daily life, assessment helps confirm the best treatment pathway.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and treatment planning for bunions and related forefoot problems.

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Types of Bunions

Bunions are often described by severity and foot shape:

• Mild bunion – small bump with occasional discomfort
• Moderate bunion – more noticeable deviation and symptoms, difficulty with shoes
• Severe bunion – significant toe deviation, pain, and pressure on other toes

Related problems can include:

• Bursitis (inflamed fluid sac over the bump)
• Second-toe crowding or hammertoe
• Calluses and corns due to rubbing/pressure
• Pain under the ball of the foot (transfer pain)

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Common Causes of Bunions

Bunions usually develop due to a combination of factors, including:

• Genetics / inherited foot shape (a major contributor)
• Ligament laxity or joint hypermobility
• Flat feet or altered foot mechanics
• Arthritis (in some cases, especially inflammatory arthritis)
• Footwear that increases pressure on the forefoot (may worsen symptoms, though it is not always the root cause)

Bunions are more common in women, but they can affect anyone.

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Symptoms of Bunions

Common symptoms include:

• A visible bump at the base of the big toe
• Pain or tenderness, especially with tight shoes or prolonged walking
• Redness, swelling or inflammation around the joint
• Difficulty finding comfortable footwear
• Calluses where the toes rub together or against shoes
• Big toe stiffness or reduced movement (especially if arthritis is present)
• Pain in the ball of the foot or second toe due to altered weight-bearing

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Diagnosis at Royal Buckinghamshire Hospital

Your consultant will assess the bunion and how it is affecting your walking and daily activity. Diagnosis may include:

• Review of symptoms, footwear issues and activity demands
• Examination of toe alignment, joint movement, and tenderness
• Assessment of foot mechanics and gait
• Imaging where appropriate, such as:
  • X-ray to assess alignment and joint changes (and to help plan treatment if surgery is being considered)

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Treatment & Management

Treatment depends on symptom severity, foot structure, and how much your bunion affects day-to-day life.

Non-surgical management

Many patients improve with:

• Footwear changes (wider toe box, softer uppers, low heel)
• Padding to reduce rubbing and pressure
• Orthotic insoles to support foot mechanics and reduce load on the joint
• Activity modification during flare-ups
• Anti-inflammatory medication or pain relief where appropriate
• Ice packs short-term for swelling after activity

Non-surgical care won’t usually “reverse” the bunion, but it often reduces pain and improves function.

Surgical treatment (when needed)

Surgery may be considered if:

• Pain persists despite appropriate footwear and conservative measures
• Symptoms significantly limit walking, work or quality of life
• There is progressive deformity with increasing functional impact

Bunion surgery aims to realign the toe and correct the underlying bone/joint position. The exact procedure depends on the severity and foot structure, and may involve bone cuts (osteotomy), soft tissue balancing, and fixation.

Your consultant will explain:

• The most appropriate procedure for your foot
• Expected recovery and weight-bearing guidance
• Potential risks, including stiffness, recurrence, or ongoing pain in some cases

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When to seek urgent help

Seek medical advice promptly if you have:

• Severe redness, heat and swelling with fever (possible infection, uncommon)
• Sudden severe pain and inability to weight-bear after injury
• Rapid worsening deformity or severe skin breakdown over the bunion

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If bunion pain is affecting your walking or footwear, contact Royal Buckinghamshire Hospital for assessment and treatment planning. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.