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Bunion Pain Overview

by Jaydee Vykoukal, PT, DPT January 31, 2020 0 Comments

Resulting from a deformity of the big toe joint, bunion pain is common, affecting over 35% of people aged 65 and older. When neglected, bunions can affect the quality of life, slowing down day to day activities and lead to pain or other symptoms. So whether it’s boot season or sandal season, it is time to do something about that hard, bony bump at the base of your big toe. Read on to learn the steps you should take to deal with a bunion.

What is a Bunion?

The big toe itself has two joints. The largest one is the MTP, or the metatarsophalangeal joint, where the metatarsal (first long bone of the foot) meets the phalanx (first bone of the toe). A bunion is a deformity that develops at the MTP joint.

Also known as hallux valgus, bunions are a musculoskeletal condition that develop when the tissue or bone at the big toe joint moves out of alignment. A bunion is initially small but can worsen over time, and as the MTP joint expands, it starts to protrude from the inside of the forefoot. Sometimes, the big toe overlaps the second toe or tucks beneath it.

Potential Bunion Characteristics

Most people do not realize when bunions need attention, especially if they start to get worse or affect the quality of life. The metatarsophalangeal joint helps us carry and distribute weight during a range of activities, so a bunion can greatly impair your foot’s functioning. It helps to be familiar with the most common bunion characteristics.

Enlarged Bunion

As a bunion progresses, you may notice all of your toes shifting outward. This occurs due to a separation between the first and second metatarsal bones, caused by an enlarged bunion. This may flexibility and mobility in your big toe. If you have a large, irritated bunion, call your doctor right away.

Skin Irritation

This type of bunion is a more serious concern because it can cause more symptoms than others. A bunion with skin irritation may be red and painful from constant rubbing. Sometimes an inflamed pocket of fluid can occur over the bump, near the surface of the skin. 

Joint Irritation

A bunion can also lead to deeper joint irritation and stiffness. Bursitis, inflammation of the pillow-like cushion near the MTP joint can also occur. This deeper-level of inflammation can be painful and harder to diagnose. 

Hallux Limitus

Many people with bunions have a condition known as hallux limitus or hallux rigidus, which means there is a limited range of motion at the joint of the big toe. It ultimately leads to poor mechanics of the big toe joint and entire  ankle complex. This affects the ability to complete normal daily activities without discomfort or pain.

Tailor’s Bunion or Bunionette

A less common issue is a bunionette or tailor’s bunion, that actually develops on the pinkie toe side of the foot. Like the bony bumps at the big toe, it occurs due to abnormal foot structure or function. Unlike other types of bunions, a bunionette grows on the outside of the foot, instead of inside. It is most commonly seen at the head of the fifth metatarsal.

What Causes Bunions

There are a lot of theories about what causes bunions on your feet, but the exact reason a bunion develops is still unknown. Medical professionals claim that years of abnormal motion and pressure on the MTP joint are to blame, while others blame tight, closed-toed shoes that roughly squeeze the toes together. 

The condition most commonly results from five major bunion causes:

  1. Foot Injuries

    Having a sprain, a fracture, or a nerve injury can make someone more susceptible to bunion deformities.

  2. Congenital Abnormalities

    Deformities present at birth may also contribute to bunion development.

  3. Heredity

    Genetic factors may be an underlying cause of bunions on feet. Bunions usually run in families. Many people with this condition have an inherited structural foot defect or a foot that rolls inward more than normal.

  4. Foot structure

    Loose joints and tendons, flat feet, and low arches all increase the risk. As a result, the feet become more prone to the growth of bunions.

  5. Rheumatoid Arthritis

    The medical community agrees that bunions are linked to certain types of arthritis, particularly inflammatory types like rheumatoid arthritis.

Bunion Symptoms

What does a bunion look like? Bunions are a progressive deformity that may or may not cause serious symptoms. Once the big toe angles toward your second toe, it can cross over the second toe and create additional issues. Call your doctor or see a specialist if you have any of the following bunion symptoms:

  • A bulging bump on the base of your big toe
  • Corns or calluses
  • Persistent and intense foot or toe pain that limits daily activities
  • Swelling and inflammation
  • Redness or soreness around your big toe
  • Inability to straighten or bend the big toe
  • Difficulty walking

How Bunions Can Harm the Foot?

An advanced bunion can dramatically change the appearance and function of the foot. Constant pressure from the inflamed and malaligned big toe will force the second toe to move out of place as well. It will then come in contact with and affect the third toe, and so on. Ultimately, the entire foot and ankle complex can get out of alignment as the bunion progresses.

Diagnosis of Foot Bunion

Even though some bunions often do not require medical treatment, it is still advisable to see your healthcare provider and have your feet checked. Accurate diagnosis is the key to choosing the right treatment.

  • Physical Examination

    Your doctor will identify a bunion by thoroughly examining your foot. Your symptoms, general health, and medical history will be discussed. To make the most out of your appointment with your doctor, have a list of questions ready. Ask if your condition is likely to be permanent or temporary and what treatment approach is recommended.

  • Bunion Pictures

    Typically, imaging is not required for a bunion. Yet, an X-ray is a quick, painless test that may help your healthcare provider determine the root cause of your condition, rate its severity, or rule out other complications like fracture or osteoarthritis.

Bunion Care

Bunions are typically a structural issue that requires consistent management, education, and a good home program. Once they develop, they are hard to reverse, and treatment usually focuses on preventing the progression of the malalignment.

Additionally, optimizing the lower body’s biomechanics with exercises or massage will minimize the risk of injuries elsewhere from bad movement patterns at the foot.

Bunion Prevention

To prevent bunions from recurring or progressing, follow your doctor’s orders. If you experience pain and stiffness that require treatment, don’t rush your recovery—your body probably needs some rest. Be patient and take good care of your feet so you will not suffer from a bunion flare-up again.

See our guide for more in-depth information and how to prevent bunions.



Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.

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