Hallux valgus is usually called a bunion: the bump on the side of the big toe. But it is more than a lump under the skin. It is a three-dimensional deformity of the big toe, the first metatarsal and the soft tissues around them, and it tends to progress over time.
What is hallux valgus?
The big toe drifts towards the smaller toes, the first metatarsal turns inwards, the joint loses its balance, the toe rotates and the way weight is spread across the foot changes. Because the deformity is three-dimensional, modern surgery aims to restore the mechanics of the foot rather than simply shave off the bump.
What causes bunions?
There is no single cause. Genetics is one of the strongest factors. Narrow, pointed shoes, high heels, flat feet, ligament laxity, a tight Achilles tendon and inflammatory arthritis can all contribute. Bunions are more common in women.
Excess movement of the first metatarsal (hypermobility) also matters. When this area is unstable, load shifts to the other toes, the deformity can progress and the risk of recurrence after surgery may rise.
What are the symptoms?
- A bump on the side of the big toe that is red and sore in shoes
- Difficulty finding comfortable footwear, especially narrow shoes
- Painful calluses under the ball of the foot (metatarsalgia)
- Deformities such as a hammer toe in the second toe
- Changes in the way you walk
How is it diagnosed?
Looking at the foot is not enough. The examination assesses how flexible the deformity is, how mobile the first metatarsal is, and the condition of the skin and other toes. Standing, weight-bearing X-rays are essential because the true size of the deformity only shows under load. The hallux valgus angle (normally under 15 degrees) and the intermetatarsal angle (normally under 9 degrees) are measured, and a CT scan may be used for a three-dimensional assessment.
Can a bunion be treated without surgery?
For mild symptoms, non-surgical measures can help. They do not correct the deformity, but they can ease pain and improve comfort:
- Wide, soft, low-heeled shoes
- Silicone toe spacers and protective pads
- Custom insoles to redistribute pressure
- Stretching, particularly when the Achilles is tight
Night splints and toe correctors do not permanently straighten the toe.
When is bunion surgery needed, and how is it done?
Surgery is considered when pain continues despite footwear changes, when symptoms limit daily life, when the deformity is progressing or when the neighbouring toes start to suffer. Surgery for appearance alone is not recommended.
The right operation differs from patient to patient. Mild and moderate deformities are usually corrected with osteotomies that realign the bone (Chevron, Scarf, Akin). For severe deformity, hypermobility or a recurrent bunion, a Lapidus procedure, which fuses the joint at the base of the first metatarsal, may be preferred. The tendons, joint capsule and ligaments also need balancing, or the deformity can return.
Assoc. Prof. Tokgöz co-authored a study on the clinical and radiological results of the distal oblique metatarsal osteotomy for hallux valgus, published in Joint Diseases and Related Surgery.
What is recovery like after bunion surgery?
It depends on the technique, but most people can walk early in a special post-operative shoe. Pain is managed with a combination of regional nerve blocks, painkillers and cooling. Swelling and tenderness are normal in the first weeks, and some swelling can last 4 to 6 months. Most people move back into normal shoes within a few months. Driving and sport depend on the type of operation.
When should I see a specialist?
It is worth having a bunion assessed when it limits the shoes you can wear, when pain affects everyday walking, when calluses form under the ball of the foot or when the second toe starts to change shape. As the deformity progresses, the operation needed to correct it can become larger. Surgery is never decided on angle measurements alone; your symptoms, expectations and daily life are discussed together, and non-surgical options are always on the table.
Frequently asked questions
Will a bunion go away on its own?
No. The deformity does not correct itself and often progresses, although non-surgical measures can ease symptoms.
Can a bunion come back after surgery?
Choosing the right procedure and balancing the soft tissues lowers the risk, but it is never zero. Risk factors such as hypermobility are taken into account when planning.
Can both feet be operated on at the same time?
It is possible for some people, but it makes the recovery period harder. Operating on one foot at a time is usually preferred, and the decision is made with you.