Condition guide
A bunion (hallux valgus) is when the big toe leans towards the other toes and its joint forms a bony lump on the inner side of the foot. The lump cannot be got rid of on your own and exercise does not correct it; but with the right shoes, pads and insoles the pain can often be eased. If the pain has a marked effect on your life, surgery is an option.
The joint at the base of the big toe moves out of alignment: the toe leans towards the second toe and the joint bulges out on the inner side. There is no direct link between the size of the lump and the pain; a large bunion may not hurt at all.
Often no single cause is found. Inherited foot structure is the strongest factor; joint conditions such as rheumatoid arthritis, feet that roll inwards and excess weight also play a part. Whether narrow, pointed shoes cause bunions is debated; but the sources agree that they squeeze an existing bunion and make it hurt.
These measures do not cure the bunion; but they can reduce secondary problems such as pain, crowding of the toes and skin breakdown. Give them 6–12 weeks to show their effect.
Surgery is considered when the bunion is very painful or has a marked effect on your life, and after other measures have been properly tried; it is not done just to improve how the foot looks. In the most common procedure the lump is removed, the bone is cut and straightened, and it is fixed with screws.
In the Cochrane review of 25 trials (1,597 adults), the trial comparing surgery with no treatment found a pain score after one year of 21 out of 100 in those who had surgery and 39 in those who were observed; the gain in function was smaller, and there was no difference in quality of life. The authors rate the certainty of the evidence as low; nothing clear can be said about rates of reoperation and side effects.
Surgery does not return the foot “to how it was”: the toe may stay stiffer or weaker, may not be completely straight, the pain may continue and the bunion sometimes comes back. Make the decision with these expectations, together with your surgeon.
Exercises at home
To be honest: there is no evidence that exercises shrink the bunion or stop it progressing. The aim of these movements is to keep the joint mobile, the calf flexible and the small muscles of the foot strong. The first two come from hospital leaflets; the others are general foot-strengthening movements. Stop any movement that causes pain.
Sit and rest your foot on your other knee. Hold your big toe with your hand and gently stretch the joint in all directions. Hold at the end of the movement without pain, then release and repeat.
Hold for 10–15 seconds, a few repetitionsStand facing a wall with your hands on it. Take the leg on the painful side back and gently stretch your calf. A tight calf increases the load on the front of the foot when walking.
30 seconds, 5–10 times a daySit with your foot flat on the floor. Tighten the muscles in the sole and raise your arch; do not curl your toes. Hold for a few seconds and relax.
10 repsSit down. Press the inner edges of your two big toes together and hold. If it hurts, skip this movement.
Hold for 5 seconds, 10 repetitionsStand upright holding onto a worktop. Lift both heels together and lower slowly. If your big toe joint hurts, do not rise as high.
10 reps, 2–3 setsHolding lightly onto a worktop, stand on one foot. This works the small muscles of the foot and your balance.
20–30 seconds, 3 times on each footVideo
YouTube videos from Manipal Hospitals in India and from the Human 2.0 Fitness channel, featuring orthopaedic surgeon Dr Chris Raynor.
A video in which an orthopaedic doctor explains the condition.
Foot exercises demonstrated by an orthopaedic surgeon.
No. You cannot get rid of a bunion or stop it progressing by yourself; the deformity cannot be permanently corrected without surgery. There is no evidence that exercises prevent progression, and the evidence for night splints is poor too. Suitable shoes, pads and insoles, however, can ease the pain.
Shoes that are wide and deep enough for your toes, with a low heel and laces or an adjustable strap, are best. Avoid high-heeled, narrow and pointed shoes. When buying shoes, have your foot measured at its widest part, that is, across the bunion.
If the bunion is very painful or has a marked effect on your life, and other measures have been tried for at least three months without enough benefit. Surgery is not done just to improve appearance. According to the Cochrane review, surgery may reduce pain by a clinically important amount compared with no treatment; the certainty of the evidence is low.
Most people go home the same day. You need to rest with your foot raised as much as possible for at least two weeks; no driving for 6–8 weeks, 2–12 weeks before returning to work, and 3–6 months before returning to sport. After surgery the toe may stay stiffer or weaker, may not be completely straight, and the bunion can sometimes come back.
See a doctor or a podiatrist in the following situations:
Sources
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