Understanding bunions (hallux valgus)
What they are, what causes them, and how to treat them — from simple measures to surgical correction.
What is a bunion?
Hallux valgus — more commonly known as a bunion — is a bony prominence that develops at the base of the big toe, accompanied by an outward deviation of the big toe towards the second toe. While the bulge is often the first thing patients notice, the condition involves a gradual change in the mechanics of the entire forefoot.
The deformity occurs when the first metatarsal bone drifts inward while the big toe angles outward, causing the joint to protrude on the inner side of the foot. Over time, the surrounding soft tissues adapt to this misalignment, which is why early treatment tends to produce better outcomes.
The severity of a bunion does not necessarily determine whether surgery is needed — the right treatment is always tailored to the individual patient.
Common symptoms
Bunions can be uncomfortable in a variety of ways, and no two patients experience them identically. These are what patients most commonly report.
Shoe rubbing
The bony prominence rubs against footwear, causing redness, soreness, and irritation.
Joint pain
Aching or sharp pain at the MTP joint at the base of the big toe.
Lesser-toe changes
Adjacent toes may develop hammer-toe or crossover deformities.
Ball-of-foot pain
Metatarsalgia can develop alongside the bunion deformity.
Severity vs. symptoms: an important distinction
One of the most important things to understand about bunions is that the size of the deformity on X-ray does not predict how much discomfort a patient will feel. Some patients with a radiographically mild bunion experience significant daily pain, while others with a large deformity manage perfectly well in wide shoes.
This is why clinical assessment matters so much. Treatment decisions are driven by the patient’s symptoms, lifestyle, and examination findings — not the X-ray alone. Severity is measured as the Hallux Valgus Angle (HVA) on a weight-bearing X-ray and guides surgical planning.
How are bunions treated?
Management ranges from simple footwear changes to surgical correction. Many patients do very well without ever needing an operation.
Swipe to see all columns
| Approach | Option | What it does | Suitable for |
|---|---|---|---|
| Conservative | Wide toe-box shoes | Reduces pressure on the joint; prevents worsening | All grades; first-line treatment |
| Conservative | Toe spacers / pads | Cushions the prominence and separates toes | Mild to moderate; symptom relief |
| Conservative | Custom orthotics | Redistributes foot pressure; slows progression | Mild to moderate; active patients |
| Surgical | Osteotomy & fixation | Realigns the bone; corrects the deformity permanently | Moderate to severe; failed conservative care |
Surgical options
Modern bunion surgery achieves excellent results with high patient satisfaction. The procedure is tailored to the severity of the deformity, and lesser-toe deformities or ball-of-foot pain can be addressed at the same time if needed.
Distal osteotomy (Scarf / Chevron)
The first metatarsal is carefully cut and shifted into correct alignment, then fixed with small titanium screws. The most widely performed technique for mild to moderate bunions — a day-case procedure with predictable, lasting correction and a rapid return to walking.
Proximal osteotomy / Lapidus procedure
A larger correction at the base of the metatarsal, or a fusion of the first tarsometatarsal joint (Lapidus), is used for severe or hypermobile deformities. It provides powerful, stable realignment and is preferred when the deformity is too large for a distal cut alone.
Minimally invasive surgery (MIS)
Small burrs and instruments are inserted through tiny puncture incisions to reshape and realign the bone without a large cut. Increasingly popular for suitable candidates thanks to reduced soft-tissue disruption, less swelling, and a faster recovery.
When should you see a specialist?
If your bunion is limiting daily activities, preventing you from wearing normal footwear, or causing persistent pain not relieved by simple measures, it is worth seeking a specialist opinion.
An orthopaedic foot and ankle surgeon can assess the severity of your deformity, discuss the full range of treatment options, and help you make an informed, personalised decision — without any obligation to proceed with surgery.
Concerned about a bunion?
A specialist offers a comprehensive assessment of your deformity and a personalised plan — whether that means footwear advice, orthotics, or surgical correction.