Hallux valgus, commonly known as a bunion, is a progressive condition where the big toe drifts toward the smaller toes. This shift causes a noticeable bump on the inside edge of the foot at the base of the big toe. The deformity results from changes in bone alignment and soft tissue balance in the front of the foot. Over time, it can cause pain, swelling, difficulty wearing shoes, and cosmetic concerns.
How Common It Is and Who Gets It? (Epidemiology)
Bunions are very common in adults and occur more frequently in women than in men. Familial clustering is common, meaning that genetics plays a role. Though they can develop in children and teenagers, they are far more frequent in adults. Ballet dancers and people who wear tight or high-heeled shoes are at higher risk.
Why It Happens – Causes (Etiology and Pathophysiology)
Hallux valgus develops from both intrinsic and extrinsic causes.
Intrinsic factors include genetic predisposition, looseness of the joint at the base of the big toe, a rounded or convex shape of the metatarsal head, flatfoot, and connective tissue laxity. Inflammatory conditions such as rheumatoid arthritis can also contribute.
Extrinsic factors include wearing high heels or narrow shoes that squeeze the toes together.
As the deformity progresses, the first metatarsal bone drifts inward while the big toe drifts outward. The tendons and ligaments around the joint become imbalanced, worsening the deformity and sometimes leading to pain in the ball of the foot (transfer metatarsalgia).
How the Body Part Normally Works (Relevant Anatomy)
The big toe and its supporting structures, known as the first ray, play a key role in balance and walking. Important components include the first metatarsal bone, the sesamoid bones beneath it, and the adductor and abductor hallucis tendons that stabilize the toe. Ligaments and the joint capsule hold the toe in alignment. When these tissues become imbalanced, the toe begins to drift outward, forming a bunion.
What You Might Feel – Symptoms (Clinical Presentation)
Patients often notice a bump on the inside of the foot near the big toe joint. Pain, swelling, redness, and difficulty wearing shoes are common. Some people feel burning or aching pain, especially after standing for long periods. In more advanced cases, the big toe may overlap the second toe, causing calluses or secondary toe deformities. Many patients also report cosmetic concerns or limited movement of the big toe.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis starts with a detailed history and physical exam. The doctor will ask about symptoms, footwear habits, and how long the problem has been present.
During the exam, they assess toe alignment, flexibility, and signs of inflammation.
Imaging: Weight-bearing X-rays are used to confirm the diagnosis and determine the severity of the deformity. Key measurements include the hallux valgus angle (the angle between the big toe and the first metatarsal) and the intermetatarsal angle (between the first and second metatarsals). X-rays also help plan surgery when needed.
Classification
Bunions are classified as mild, moderate, or severe based on the measured angles on X-rays. The position of the sesamoid bones beneath the joint also helps grade severity. These classifications guide treatment planning and surgical technique selection.
Other Problems That Can Feel Similar (Differential Diagnosis)
Several other conditions may mimic bunion symptoms, including:
- Hallux rigidus: Arthritis and stiffness of the big toe joint.
- Hallux varus: Overcorrection of a previous bunion surgery.
- Gouty bunion: Inflammation caused by uric acid crystal buildup.
- Inflammatory bunion: Seen in conditions like rheumatoid arthritis.
Treatment Options
Non-Surgical Care
Most patients begin with conservative treatment.
- Wearing wide, comfortable shoes with a low heel can relieve pressure.
- Using toe spacers, pads, or orthotic inserts may reduce pain but do not correct the deformity.
- Stretching and physical therapy can improve flexibility.
- Pain medication or injections may reduce inflammation.
These measures can improve comfort but will not reverse the alignment changes.
Surgical Care
Surgery is considered when pain persists despite conservative care or when the bunion significantly interferes with daily life.
Procedures are chosen based on the deformity’s severity and joint flexibility:
- Distal metatarsal osteotomy (cutting and realigning the bone) for mild deformities.
- Proximal osteotomy or combined procedures for larger deformities.
- First tarsometatarsal fusion (Lapidus procedure) for severe cases or joint instability.
Soft tissue procedures such as lateral release and medial capsule tightening are often performed in combination.
For young patients, non-surgical care is preferred until growth is complete, as early surgery may increase the risk of recurrence.
Recovery and What to Expect After Treatment
After surgery, patients typically wear a protective shoe or boot for several weeks. Weight-bearing is usually limited initially and then gradually increased. Physical therapy helps restore motion, strength, and gait. Most people return to normal shoes within 6–12 weeks, though complete recovery can take several months. Mild swelling may persist for up to a year.
Possible Risks or Side Effects (Complications)
Possible complications include recurrence of the bunion, overcorrection into a hallux varus deformity (where the toe turns inward), nerve irritation, stiffness, or pain under the smaller toes. In rare cases, bone healing problems or infection can occur.
Long-Term Outlook (Prognosis)
When the correct procedure is matched to the severity of the deformity, patients typically enjoy good pain relief and improved function. However, recurrence can occur if the underlying biomechanical issues, such as flatfoot or joint instability, are not addressed.
Out-of-Pocket Costs
Medicare
CPT Code 28296 – Bunionectomy with Osteotomy
Estimated Out-of-Pocket Cost: $157.25
Under Medicare Part B, about 80% of the approved amount is covered after the deductible. Supplemental or Medigap insurance usually covers the remaining 20%, leaving little to no cost for patients. Secondary coverage like TRICARE or employer health plans may also fill in gaps.
Workers’ Compensation
Workers’ compensation typically covers both non-surgical and surgical care if the bunion developed or worsened due to workplace activity or footwear requirements. There are no out-of-pocket costs for authorized treatment.
No-Fault Insurance
If the bunion resulted from a car accident, no-fault insurance may pay for evaluation, therapy, and surgery when medically necessary. Coverage limits depend on the policy.
Example:
A patient with Medicare and a Medigap plan who undergoes CPT 28296 bunion surgery at an ambulatory center may pay $0–$50 total, depending on copays and facility fees.
Frequently Asked Questions (FAQ)
Is a bunion just a bump?
No. A bunion is a deformity involving bone and soft tissue misalignment, not just a bump.
Can bunions go away without surgery?
No, conservative treatments help relieve pain but do not reverse the deformity.
When should I consider surgery?
If pain interferes with walking or shoe wear despite non-surgical care, surgery may be considered.
Can the bunion come back after surgery?
Yes, recurrence is possible, especially if joint instability or flatfoot is not addressed.
Summary and Takeaway
Hallux valgus, or bunion, is a common and progressive deformity that can cause pain, difficulty wearing shoes, and functional problems. Early treatment focuses on comfort and slowing progression. Surgical options can correct alignment and relieve pain when conservative care no longer helps. With appropriate treatment and footwear, most patients regain comfort and function.
Clinical Insight & Recent Findings
A 2024 systematic review by Khan and Patil evaluated various therapeutic approaches for hallux valgus and found that both conservative and surgical treatments can improve symptoms, but their goals differ.
Nonsurgical methods—such as soft tissue mobilization, stretching, kinesiology taping, and foot-strengthening exercises—help reduce pain, improve mobility, and enhance gait, though they do not permanently correct the deformity.
Surgical procedures, including osteotomies and soft tissue balancing techniques, remain the mainstay for moderate to severe cases, offering better long-term correction when followed by structured physiotherapy. Postoperative rehabilitation emphasizing range of motion, muscle strengthening, and gait retraining is critical to restoring proper function and minimizing recurrence. (“Study on physical therapy and surgical outcomes for bunions – see PubMed.”)
Who Performs This Treatment? (Specialists and Team Involved)
Bunion treatment is managed by an orthopedic foot and ankle surgeon or podiatric surgeon. The care team often includes an anesthesiologist, nurse, and physical therapist who help manage surgery, recovery, and rehabilitation.
When to See a Specialist?
You should see a specialist if you have persistent foot pain, visible deformity, difficulty finding comfortable shoes, or symptoms that interfere with daily activities. Early evaluation can prevent progression and help determine the best treatment plan.
When to Go to the Emergency Room?
Seek emergency care if you have sudden, severe foot pain, inability to bear weight, visible deformity after trauma, or signs of infection such as redness, warmth, or drainage—especially if you have diabetes.
What Recovery Really Looks Like?
Recovery can involve several weeks of limited activity and footwear restrictions. Swelling and stiffness are normal early on but gradually improve. Physical therapy and supportive shoes help restore mobility and prevent recurrence.
What Happens If You Ignore It?
If untreated, bunions can worsen over time, leading to chronic pain, overlapping toes, calluses, and difficulty walking. Severe deformities may require more complex surgeries and longer recovery times.
How to Prevent It?
Choose shoes with a wide toe box, low heel, and good arch support. Stretch your feet regularly, strengthen foot muscles, and avoid shoes that squeeze the toes. Early management of flatfoot or joint laxity can reduce risk.
Nutrition and Bone or Joint Health
A diet rich in calcium, vitamin D, and protein supports bone strength and healing. Staying hydrated and maintaining a healthy weight can reduce stress on the feet and joints.
Activity and Lifestyle Modifications
After treatment, patients are encouraged to return gradually to normal activity. Low-impact exercises such as walking, cycling, and swimming are safe. Avoid tight shoes and high heels, and maintain proper foot alignment through supportive footwear and regular stretching.
