Treating bunions

A bunion may only need to be treated if it's severe and causing significant pain and discomfort.

The various treatments for bunionsare outlined below. You can also read a summary of the pros and cons of the treatments for bunions , allowing you to compare your treatment options.

Non-surgical treatment

If possible, non-surgical treatment for bunions will be used, which your GP can discuss with you.

Non-surgical treatments can ease the pain and discomfort caused by a bunion, but they can't change the shape of your foot or prevent a bunion from getting worse over time.

Non-surgical treatments include:

• painkillers
• bunion pads
• orthotics
• wearing suitable footwear

These are discussed in more detail below.

Painkillers

If your bunion is painful, over-the-counterpainkillers such as paracetamol or Painkillers, 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

Bunion pads may also 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 stop your foot rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe.

Orthotics

Orthotics are placed inside your shoes to help realign the bones of your foot. Theymay helprelieve the pressure on your bunion, which can ease the pain. However, there's little evidence that orthotics are effective in the long term.

It's important that the orthotic fitsproperly, 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 podiatristto 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's little evidence that 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 because they often compete with the bunion for the already limited space in the shoe.

Ice packs

If your toe joint is painful and swollen, applying an ice pack to the affected area several times a day can help to relieve the pain and inflammation.

Never apply ice directly to your skin. Wrap it in a cloth or tea towel. A bag of frozenvegetables makes a good ice pack.

Suitable footwear

It's recommended that you wear flat or low-heeled, wide-fitting shoes if you have a bunion. Shoes made from soft leather are ideal because they'll 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.

Surgery

Surgery is the only way to correct a bunion. A bunion willusually get worse over time, so if it's left untreated it's 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 surgery is to relieve pain and improve the alignment of your big toe. Surgery isn't usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear.

Bunion surgery isoften carried outas a day procedure, which means you won't have to stay in hospital overnight.The procedure will either be carried out under a local anaesthetic or a general anaesthetic .

Deciding to have surgery

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

• your age in children, bunion surgery is often delayedbecause ofthe risk of the bunion returning
• your medical history and general health problemswith wound healing and infections are more likely in certain conditions such as diabetes ; youre also more likely to develop problems if your bunion is caused by a condition such as rheumatoid arthritis
• your occupation and lifestyle bunion surgery can make your toes less flexible, and you may be unable to return to the same level of physical activity
• your expectations of surgery bunion surgery has about an 85% success rate, but there's no guarantee that your foot will be perfectly straight or pain-free; the success of surgery depends on the type of procedure, the experience of the surgeon and your ability to rest after the operation
• the severity of your symptoms surgery will usually only be recommended if your bunions are causing considerable pain and non-surgical treatments have been unsuccessful

Types of surgery

There are a number of 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 described below.

Osteotomy

Osteotomy is the most commonly used and proventype 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'll also move your toe joint back in line, which may involve removing other pieces of bone, possibly from the neighbouring toes.

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).

The procedure is usually only recommended for people with severe deformities of the big toe joint, which make it too difficult for doctors to completely fix the joint, or when there's advanced degeneration of the joint.

After arthrodesis, the movement of your big toe will be severely limited and you won't be able to wear high heels.

Excision (Keller's) arthroplasty

An excision arthroplasty involves removing the bunion and thetoe joint.A false joint is created by scar tissue that forms as a result of the operation.

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

In 2010, the National Institute for Health and Care Excellence (NICE) published guidance about a minimally invasive surgical procedure to treat bunions.The aim of the procedure is to repairthe tilting of the big toe.

The technique can be carried out under a local anaesthetic or a general anaesthetic , using X-rays or an endoscope for guidance. The type of endoscope used will be a long, thin, rigidtube with a light source and video camera at one end

One or more incisions will be made near the big toe so that bone-cutting instruments can be inserted. These will be used to remove the bunion and to divide one or more bones located at the front of the foot.

Wires, screws or plates will be used to keep the divided bones in place. 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. You may be given a special surgical shoe that enables you to walk on your heel.

As the procedure is relatively new, there's little in the way of reliable evidence regarding its safety or effectiveness.

See the NICE guidance about the surgical correction of hallux valgus using minimal access techniques (PDF, 93kb) .

After surgery

After bunion surgery, your foot and ankle may be swollen for three months or longer. While you're recovering, you'll need to keep your foot raised to reduce swelling, and you'll need crutches to move around.

It's likely that you'll be unable to wear normal shoes for at least sixmonths 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.