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A bunion is a deformity of the lower joint of the big toe. It is medically termed hallux valgus. It should not be confused with medial bursitis of the big toe, which is inflammation of a bursa, the fluid sac between the bones in a joint. Medial bursitis is usually temporary, and is cured by resting the affected joint. A bunion, by contrast, unless treated surgically, is permanent.

What are the symptoms of a bunion?

Your big toe is angled inwards, towards the middle of your foot. At the same time, the top of your first metatarsal – the bone that links with your big toe – sticks out at the side near your big toe, making your foot wider. This may cause pain, loss of balance, it may make it difficult to walk and you may be prone to falling. You may also have a limited range of movement of your big toe.

How common are bunions and who gets them?

Best estimates suggest that in the Western world, more than 20% of people aged 18 to 65 and more than 35% of people aged over 65 have bunions. They are more than twice as common in women as in men but are relatively rare in children.

Bunions are rare in societies in which people do not wear shoes. Conversely, they are more common in people whose work places great strain on their feet such as in ballet dancers and professional footballers.

What causes bunions?

The main causes of bunions are:

  • Footwear: badly fitting footwear, especially high-heeled shoes, increases the risk.
  • Arthritis: rheumatoid arthritis, psoriatic arthritis and gout are risk factors for bunions.
  • Neuromuscular disorders: these include cerebral palsy and multiple sclerosis.
  • Genetics: bunions tend to go in families, so hereditary factors are implicated.
  • Connective tissue disorders: these include Down’s syndrome, a genetic disorder associated with learning difficulties and diverse physical abnormalities, including loose joints, and Marfan’s syndrome, a genetic disorder associated with long limbs and increased height.

How can I avoid them?

The best way to avoid them is to avoid poorly fitting shoes. High-heeled shoes are important risk factors as are tightly fitting. The best shoes are those made of soft leather or other soft material, and that have a wide fitting. Walking barefoot, where possible, will also reduce the risk.

How do I diagnose a bunion?

If your foot is obviously deformed, as described above, and you feel pain, the odds are you have a bunion. Your medical doctor will confirm diagnosis by examining your foot and by X-ray.

What do I do if I have a bunion?

Bunions tend to get progressively worse. There is no cure for them other than surgery, and even surgery does not guarantee a cure. You can, however, manage your life. Non-surgical interventions include the following:

  • Footwear: wear comfortable shoes.
  • Painkillers: over-the-counter painkillers such as ibuprofen and paracetamol may relieve pain. You may also relieve pain by applying an ice pack to your bunion.
  • Bunion pads: these are pads you place over your bunion. They prevent it from rubbing on the side of your shoe and therefore prevent pain. The pads are available over-the-counter from pharmacists.
  • Orthoses: these are orthopaedic devices used to correct a malformed joint, in the case of a bunion, the first metatarsal and the big toe. The orthosis fits inside your shoe. You can buy one over-the-counter from a pharmacist or your GP may refer you to a podiatrist, a specialist in foot disorders. A podiatrist will advise which orthosis is best for you and, if your bunion is severe, may have one custom-made for you.

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