The chief sign of a bunion is the big toe bending towards the other toes of the same foot causing a protruding structure medially. Bunions usually cause pain and soreness around the toes and redness of the skin. A swollen bony structure is seen on the medial side of the foot. Bunions can cause difficulty and pain when wearing shoes.
The skin where the big toe overlaps the second toe becomes hard and reddened. The overall shape of the foot is changed due to the bunion. The bunion increases the width of the foot making it difficult to find a well fitting shoe. The big toe is normally used to thrust the foot forward and maintain balance. Due to bunion formation these functions are affected and hence, it may cause difficulty in walking. Due to friction, blisters are commonly seen to form over the bunion and other toes.
The bony bump and swelling formed due to the bending of the big toe is indicative of bunion formation. History will include pain, discomfort, soreness and redness around the joint. One may check the range of movement of the toes. Details regarding the types of footwear used will also be needed which will usually include history of wearing poorly-fitting or narrow-fitting footwear. In case any family history of such bunions is present, then it must be mentioned.
Laboratory studies can benefit the surgeons to check out for any other accompanying conditions or problems. A complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) will help to rule out any existing infections. A test to check RA factor and uric acid are needed for assessment of rheumatoid arthritis or gout accompanying the bunion formation.
An X-ray may be advised to check its severity, causes and prognosis. A standing foot X-ray in AP and Lateral planes is obligatory to determine the type of surgery required for bunion rectification . Also, an oblique, non-standing film can be taken for a different view of the metatarsal head and hind foot. In cases, where the sesamoid bone appears to be affected (eg. fracture or avascular necrosis), an x-ray of the sesamoid view may be necessary. All this history and X-ray information is combined and then the best surgical procedure to be done for the patient is decided.
When treating a patient with a bunion, it is necessary to be aware of the patient’s demands and expectations from the treatment .
Conservative treatment includes changes in the footwear and use of different orthotics i.e. padding and shielding in the shoes. Resting the foot and applying ice can help soothe symptoms. Painkillers such as paracetamol or ibuprofen help in relieving the pain. In case of infections antibiotics may be used. These treatments aim to relieve the symptoms and do not correct the actual deformity.
Surgery is performed by an orthopaedics or podiatric surgeon in cases where the discomfort is severe or when a deformity needs to be corrected. Understanding and distinguishing each component of the deformity is the key to successful surgery. Surgery is intended to straighten the joint and relieve the pain and not only to enhance to external look of the foot. There are different types of surgeries used to treat bunions. The choice depends on the severity of the bunions, size and shape of foot, accompanying conditions like arthritis, age of the patient and his health status. One must examine and assess the vascular status, any neuropathies if present, arthritis, muscle strength and tightness, the range of motion of the first MTP joint. Also, check for signs of general ligamentous laxity  . The operations range from trimming parts of the joint, to complete artificial replacement of the big toe joint. Commonly osteotomy is performed. Presently local anaesthesia is preferred over general or spinal anaesthesia for the surgery.
When treatment is directed to each element of the deformity, then satisfactory results are achieved. When surgery is performed one can get long-term relief from discomfort and deformity. Since bunion is a progressive deformity, one has to be careful even after surgery to avoid recurrence. It is important to check the severity and rule out other underlying problems like gout, RA etc. for better prognosis.
Post-surgery patients must use comfortable foot-wear and take utmost care to avoid ill-fitting or narrow shoes for long term relief form bunions. Recurrent deformity and stiffness are the common complications seen.
Studies show that bunions are linked to one’s family history, the inheritance pattern being autosomal dominant with incomplete penetrance .
Poorly or ill fitting, narrow, tight or small shoes are also known to cause bunions or at least worsen the situation . Wearing heeled shoes contributes to bunion formation   . A study done amongst people from Asian and Chinese cultures that don’t wear shoes, no cases of bunions were found, adding credibility to the theory that bunions result from ill-fitting shoes .
Other causes which are inherited include joint flexibility and arch height . Loose ligaments and low muscle tone increase chances of bunion development. Neuromuscular conditions like cerebral palsy or connective tissue disorders can precipitate bunion formation. Arthritis like rheumatic or psoriatic arthritis or gout can also be responsible for bunions.
The prevalence of bunions is significantly high in females as compared to males. The female to male ratio is 8 to 9:1 and going as high as 15:1  . The main reasons for this difference in the prevalence are due to the footwear habits  . The initial changes tend to occur during adolescence or may be even earlier in cases of children suffering from bunions but the main onset is observed to be in the age group of 30 to 60 years  .
Bunions are researched to be genetic. The basic factors involved could be flat-feet, increased flexibility of the ligaments, abnormally structured bones and/or neurological factors. Certain studies conclude that poorly or ill fitting footwear are the main causes of bunions. There are other studies which conclude that the main causes are genetic and that footwear only worsens or aggravates the condition which is related to the genetic bony make-up.
When the shoes are too tight or narrow, they tend to rub against the big toe joint. Most high-heeled shoes are tight and narrow from the front causing the great toe to bend inwards nearer the second toe. This bending and pressing of the toe can cause pain due to nerve impingement. Also, due to high-heeled shoes the entire body weight is transferred onto the front foot straining the toe joints.
One can prevent bunions by wearing good well-fitting footwear. Avoid foot-wear that is narrow or tight. High-heeled or pointed shoes increase the chances of bunion formation. Use padding to prevent bunions from further injury. Try the shoes on both feet. Use an insole for the shoe which is loose but don’t cramp the larger foot by using a smaller shoe. For flat-feet use arch supports or orthotic shoe inserts.
A bunion is a bony deformity of the joint base of the great toe. It is also called Hallux vagus. Hallux = great toe, valgus = abnormal angulation of the great toe associated with bunion anomalies and abductus = abnormal drifting or inward leaning towards the second toe.
It involves the first toe, with first phalanx abduction and pronation, and first metatarsal adduction, pronation, and elevation, along with capsular and ligamentous derangement  .
A bunion is a bony deformity at the base of the great toe of the foot. The great toe gets angled towards the second toe forming a bump sticking outwards. This changes the shape of the foot causing swelling, pain and tenderness around the big toe. The causes are unclear but studies prove it is inherited in the family. Ill-fitting footwear which is narrow, pointed or tight is known to cause bunions. Due to narrow shoes the bones of the toe are pushed inwards towards the other toes. The skin over the angled joint tends to rub on the inside of the shoes. This leads to thickening, inflammation of the overlying skin and tissues surrounding the affected joint.
Wearing high-heeled shoes puts entire body weight on the toes. The feet are squeezed and the big toe remains bent which causes nerve damage and pain. It can be diagnosed by looking at it. An X-ray of the foot helps to evaluate the severity of the deformity and understand the structural abnormality of the toes. This information is needed to decide the treatment methods.
Conservative treatment includes rest, ice application, painkillers and change of footwear. Surgery is a chosen to improve the appearance of the foot and to straighten the joint with long term pain relief. Post-surgery one must be choose footwear which is comfortable and wide fitting to prevent recurrences.