Can a bunion be corrected without surgery?

What is a bunion?

A bunion, known medically as hallux valgus, develops when the big toe drifts towards the smaller toes and the bone behind it, the first metatarsal, angles outwards. This creates a bony bump on the inside of the foot at the base of the big toe. The skin over the bump can become red, thickened and sore from rubbing on shoes.

Bunions tend to run in families and are more common in women. Narrow, pointed or high-heeled shoes can worsen symptoms, although genetics and foot structure play a major role in their development.

What symptoms do bunions cause?

Common symptoms include pain over the bump, especially in tight shoes, stiffness of the big toe joint, hard skin under the ball of the foot, and difficulty finding comfortable footwear. The second toe may become painful or start to overlap the big toe.

Some people have large bunions with little pain, while others have significant pain with a smaller deformity. Treatment is guided by symptoms rather than appearance.

Do splints, insoles or exercises correct bunions?

A Cochrane review of treatments for hallux valgus found three trials with 332 participants that compared conservative treatments with no treatment 1. There was no evidence of a difference in outcomes between treatment and no treatment. The quality of trials in the review was generally poor and their sizes small 1.

In one trial of 140 participants, surgery with a chevron osteotomy, a procedure that cuts and realigns the bone, improved outcomes compared with foot orthoses or no treatment 1. Non-surgical options may still help comfort, but they do not realign the toe.

What helps reduce bunion pain?

Wearing shoes with a wide, deep toe box, soft uppers and low heels reduces pressure on the bump. Bunion pads or gel sleeves can protect the skin. Insoles may help redistribute pressure under the foot, particularly when there is pain under the ball of the foot.

Toe spacers and night splints may feel comfortable for some people. Exercises that maintain big toe mobility and strengthen the small muscles of the foot are sometimes used, although evidence for their effect on the deformity is limited.

When is surgery considered?

Surgery is considered when bunion pain continues to limit walking, work or daily activities despite footwear changes and other measures. Surgery for cosmetic reasons alone is generally not recommended because of the risks and recovery time.

There are many surgical techniques, and the choice depends on the severity of the deformity and the condition of the joint. Recovery usually involves wearing a special shoe for several weeks, and swelling can last months.

What is recovery like after bunion surgery?

People are often able to walk in a protective shoe soon after surgery, but need to limit activity and raise the foot to control swelling in the first weeks. Returning to normal footwear often takes around six to twelve weeks, and full recovery can take six months or longer.

Rehabilitation may include exercises to restore big toe movement, strength and balance. Following the surgeon's advice on weight-bearing is important for healing.

How can I choose shoes for bunions?

Look for shoes with a wide and deep toe box, soft and stretchy uppers, low heels and minimal seams over the bunion. Shopping later in the day, when feet are slightly larger, and trying shoes with any insoles you use helps ensure a comfortable fit.

Shoes with laces or adjustable straps allow the fit to be changed as needed. Avoid narrow, pointed and high-heeled shoes, which push the big toe towards the other toes.

When should foot pain be checked by a doctor?

Seek assessment for a hot, red, swollen big toe joint, which may indicate gout or infection, particularly with fever. People with diabetes or poor circulation should have any skin breakdown over a bunion checked promptly.

Pain that persists despite footwear changes, or a rapidly changing foot shape, should also be reviewed.

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