Treatments for bunions

Bunions may only need to be treated if the deformity is severe and you experience significant pain and discomfort.

Non-surgical treatment

Where possible, non-surgical treatment for bunions will be used. Your GP can discuss the options with you.

Non-surgical treatments can ease the pain and discomfort caused by a bunion but cannot prevent a bunion from becoming worse over time.

Possible non-surgical treatments include:

  • painkillers
  • bunion pads
  • orthotics
  • wearing suitable footwear

These are discussed in more detail below.

Painkillers

If you have a painful bunion, painkillers, such as paracetamol or ibuprofen, may be recommended.

When using painkillers, always read the patient information leaflet that comes with the medicine and follow the recommended dose.

Bunion pads

As well as taking painkillers, using bunion pads may ease the pain of a bunion.

Reusable bunion pads, made of either gel or fleece, are available over the counter from pharmacies. Some are adhesive and stick over the bunion, while others are held against your foot by a small loop that fits over your big toe.

Bunion pads protect your foot from rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe. You can also use an ice pack or cold compress to help numb pain and reduce any swelling (see below).

Orthotics

Orthotics are devices placed inside your shoes which help realign the bones of your foot. They may help relieve the pressure on your bunion, which can ease the pain. However, there is little evidence orthotics are effective in the long term.

It is important the orthotic fits properly, so you may want to seek advice from your GP or podiatrist (a specialist in diagnosing and treating foot conditions), who can suggest the best ones for you.

You can buy orthotics over the counter from pharmacies or they can be custom made by a podiatrist to fit your feet. Whether you need to buy an over the counter orthotic or have one specially made will depend on your individual circumstances and the severity of your bunion.

You can also use special bunion splints, worn over the top of your foot and your big toe to help straighten its alignment. Splints are available for both daytime and night-time use. However, there is little evidence to indicate splints are effective.

Toe spacers are also available, which can help reduce the pain caused by bunions.

However toe spacers or orthotics may be of limited use as they often compete with the bunion for the already limited space in the shoe.

Ice packs

If your toe joint is painful and inflamed, applying an ice pack to the affected area several times a day can relieve pain and inflammation. Never apply ice directly to the skin, wrap it in a cloth or tea towel first. A bag of frozen vegetables makes a good ice pack.

Suitable footwear

If you have a bunion, you are advised to wear flat or low-heeled, wide-fitting shoes. Shoes made from soft leather are ideal because they will relieve any pressure on the bunion.

Avoid narrow or slip on shoes. High heels can also make your bunion worse by putting excessive pressure on your toes.

Surgical treatments

Surgery is the only way to correct a bunion. Bunions usually get worse over time, so a bunion left untreated is likely to get bigger and become more painful.

If your bunion is causing a significant amount of pain and affecting your quality of life, your GP may refer you to be assessed for bunion surgery.

The aim of bunion surgery is to relieve pain and improve the alignment of your big toe. Surgery is not usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear.

The operation will either be carried out under local anaesthetic or general anaesthetic.

Bunion surgery is often performed as a day procedure, which means you will not have to stay overnight in hospital.

Deciding to have surgery

When deciding whether to have bunion surgery, there are several things to consider, including:

  • your age
  • your medical history and general health
  • your occupation and lifestyle
  • your expectations of surgery
  • the severity of your symptoms

These are discussed in more detail below.

Age

Your age will be taken into consideration when deciding on bunion surgery. In children, bunion surgery is often delayed due to an increased risk of the bunion returning. This is because the bones are still growing.
You may be advised that non-surgical treatments are a better option than bunion surgery.

Medical history and general health

After surgery, your risk of developing problems is increased if you have other medical conditions that prevent or slow down the healing process. For example, problems with wound healing and infection are more likely if you have diabetes or problems with your circulation.

Following bunion surgery, you are also more likely to encounter problems if your bunion occurred as a result of another condition, such as rheumatoid arthritis.

Occupation and lifestyle

If you are a professional dancer or sportsperson, bunion surgery may only be recommended if you are unable to perform in your chosen field.

If you are very active and play a lot of sport, being able to move your big toe freely may be more important to you than how your toe looks.

Bunion surgery can make your toes less flexible, meaning you may not be able to return to the same level of physical activity as before the operation.

Your expectations of surgery

The success of your surgery will depend on the skill and experience of the surgeon, the severity of your bunions, the type of surgical procedure you have and your ability and willingness to rest after the operation.

Bunion surgery may be up to 85% successful in people who have it. However, after you have had surgery, there is no guarantee your foot will be perfectly straight or pain free. Surgery may reduce the flexibility of your big toe joint and you may experience stiffness in the area where the bunion was. Your toe may also be shorter than it was before you had surgery.

The severity of your bunion

Surgery will only usually be recommended if your bunions cause considerable pain and non-surgical treatment has failed. This is because of the risks and complications associated with bunion surgery.

Your specialist will examine your foot and look at the results of your scans to assess the severity of your bunions and will help you decide whether surgery is right for you.

Types of surgery

There are many different surgical procedures used to treat bunions. The type of surgery recommended for you will depend on the severity of the deformity.

Your surgeon may use pins, wires or screws to hold the bones in place while they heal. Depending on the type of surgery you have, these may be left in your foot or removed later on.

Some of the surgical procedures for bunions are outlined below.

Osteotomy

An osteotomy is the most common type of bunion surgery. Although there are many different types of osteotomy, they generally involve cutting and removing part of the bone in your toe.

During the procedure, your surgeon will remove the bony lump and realign the bones inside your big toe. They will also move your toe joint back in line, which may involve removing other pieces of bone.

A procedure called distal soft tissue realignment may be combined with an osteotomy. This involves altering the tissue in your foot to help correct the deformity and improve the stability and appearance of the foot.

Arthrodesis

Arthrodesis involves fusing together two bones in your big toe joint (metatarsophalangeal joint). This procedure is usually only recommended for people who have severe deformities of the big toe joint, which make it too difficult for doctors to completely fix the joint or when there is advanced degeneration of the joint.

After arthrodesis, the movement of your big toe will be severely limited.

Excision (Keller's) arthroplasty

An excision arthroplasty involves cutting out the bunion and part of the bone of the joint at the base of the big toe. This creates a false joint that later heals when scar tissue forms. The procedure involves pinning the joint in place with wires, which will be removed around three weeks after surgery is carried out.

An excision arthroplasty can only be used in certain circumstances, and is usually reserved for severe, troublesome bunions in elderly people.

Minimally invasive bunion surgery

The National Institute for Health and Care Excellence (NICE) has published information about a new, minimally invasive surgical procedure that can be used to treat bunions. However, as the procedure is new, there is currently little reliable evidence of how effective or safe it is.

Whichever type of surgery you have, you will be under a local anaesthetic or general anaesthetic. One or more incisions will be made near the big toe so that bone-cutting instruments can be inserted. These are used to remove the bunion and to divide one or more bones located at the front of the foot.

The procedure aims to repair the tilting of the big toe and uses wires, screws or plates to keep the divided bones in place. It may be carried out using X-rays.

After the procedure, you may need to wear a plaster cast or dressing to keep your foot in the correct position until the bones have healed. It is likely you will given a special surgical shoe that enables you to walk on your heel.

After surgery

After bunion surgery, expect your foot and ankle to be swollen for three months or longer. While you are recovering, you will need to elevate your foot to reduce swelling and you will need crutches to move around.

You will not usually be able to wear normal shoes for at least six months after surgery. You may have a cast or bandage and postoperative shoes (shoes specially designed to allow heel walking and protect the bony cuts) before you can start wearing regular footwear. This will keep the bones and soft tissues in place while they heal.

Last revised: 1 November 2012

Next review: 1 November 2014

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