Bunions

Bunion pain may arise from several sources:

• Shoe pressure: The bony lump may rub against footwear, causing irritation, inflammation, and skin changes.
• Joint pain: In some patients, the bunion joint itself (the first metatarsophalangeal joint) becomes arthritic or inflamed, leading to pain inside the joint.
• Secondary conditions: Overloading of other forefoot structures may cause additional pain even if the bunion itself seems mild.

Diagnosis is based on:

• Clinical examination
• Detailed biomechanical assessment
• X-rays, which remain the gold standard for evaluating bunion severity, joint degeneration, and surgical planning.

Yes — in selected cases, conservative treatment can help relieve pain and slow progression, though it will not correct the deformity itself.

Non-surgical treatments may include:

• Footwear modification: Wider, more accommodating shoes can reduce pressure on the bunion.
• Custom orthotic devices: Designed to optimise foot function and reduce abnormal joint loading, particularly helpful if pain is located inside the joint.
• Activity modification and physiotherapy: May assist with pain control and improve function.
• Pain relief measures: Anti-inflammatories, ice, and padding may provide temporary symptom relief.

Although non-surgical management can reduce symptoms, only surgery can correct the bunion deformity. If conservative measures fail — especially when joint pain is significant or deformity continues to progress — surgical correction may be necessary to restore alignment and prevent further deterioration.

Surprisingly, over 100 different bunion procedures have been described worldwide. Only a small number of these are routinely effective and appropriate. Mr. McCulloch has extensive surgical experience across the full spectrum of bunion procedures, ranging from:

• Minimally invasive bunion surgery
• Traditional open surgery
• Complex reconstruction techniques

Each procedure is carefully selected based on the specific type, severity, and structural cause of the bunion. X-rays are essential in determining the most appropriate surgical plan.

Many studies have been done to try and determine what causes a bunion, but the cause is multifactorial. For example, some patients have a broad foot type, and by wearing tight, narrow footwear, the toe has been pushed over. In some cases, the first metatarsal develops in a more inwardly pointed position, and this can also cause a bunion to form. Sometimes, it is a genetic cause, and hypermobility (joint laxity) has been associated with bunion formation.

Generally, not. If the bunion is established, it is very hard to reverse. Some studies in children have shown a splint can be helpful in the short term, but it does not cure it.

There are literally hundreds of devices on the market for bunions. Unfortunately, there is no evidence that any of them work. However, in the initial stages of the development of a bunion, home treatments such as wide footwear and bunion splints can minimize the symptoms. In addition, there is evidence that an orthotic can help with bunion pain and some anecdotal experiences which would suggest that the bunion can appear slightly improved with an orthotic when used for long-term, although the scientific research is not there yet.

This is very difficult if the bunion is due to a bony deformity. However, some bunions are caused by fluid build-up called a bursa. Using anti-inflammatories can reduce inflammation, which can be effective and improve comfort. However, the underlying cause, which is a misalignment of the foot bones, cannot be treated without surgery.

Generally speaking, it is very hard to get rid of bunions once they are established, except for the soft tissue swelling, which can improve with anti-inflammatory measures.

If you have an established bunion deformity where the bones have moved, then surgery is the only way to remove them.

In many cases, a bunion can be managed conservatively by wearing wide shoes and orthotics, but if the bunion is too established and causes problems because of footwear pressure, it may be necessary to consider surgery.

Bunion surgery is generally tolerated very well by patients. Here, at The London Podiatry Centre, the procedure takes less than an hour and is performed under local anaesthetic. A patient is provided with painkillers and long-lasting anaesthetic afterwards, which keeps any discomfort very manageable. Typically, you might experience pain levels of 4 to 5/10 when the anaesthetic wears off, but this does not last more than a day or two.

This depends on your individual circumstances. For some people, surgery is the only answer because they want to get rid of the deformity and associated pain. In other cases, the problem can be managed with wide footwear, orthotics and other conservative treatments.

Relatively mild bunions can cause significant pain and, in this instance, surgery might be necessary. In other cases, a severe bunion in terms of the level of deformity may not cause too many problems because the patient wears wide shoes. Therefore, it is not necessarily the extent of the deformity that determines the surgery. However, one factor that can be very helpful in determining whether to have bunion surgery is whether the first toe is beginning to deform the rest of the foot. In many ways, it would be better to have surgery before this occurs as otherwise, surgery to correct the bunion might also involve a further procedure to correct the lesser toes that have become affected by the bunion deformity.

Typically, it is 6-8 weeks before you can be active to within reasonably normal levels. You will be provided with a protective shoe or boot to use during this time. Stitches are generally removed at week 2. However, it will be several months before you begin to function normally, and improvements can be expected for up to a year.

There are about 100 different bunion operations, with some being far more popular than others. Minimally invasive (keyhole) surgery has become more popular, but patients have to be selected carefully as in some cases, it is simply not worth having minimally invasive surgery because of the reduced risk of an optimal outcome. Ron McCulloch at The London Podiatry Centre has performed minimally invasive surgery and will consider it. Still, in most instances, open surgery can be a better option for patients. This is because minimally invasive surgery limits what the surgeon can see when performing the operation, which means that not as many steps can be undertaken to fully correct the deformity.

This depends entirely on the type of bunion that you have. However, one of the most common procedures in the UK is a Scarf osteotomy. This involves cutting a ‘Z’ in the bone, realigning it, and then fixing it with wires or screws. This is one of the preferred procedures at the London Podiatry Centre.

There are up to a hundred different types of operations but the most popular includes the scarf osteotomy, which involves cutting a long ‘Z’ in the bone, A Chevron osteotomy which involves cutting a ‘V’ in the bone, and a Lapidus procedure which involves fusing the joint in the middle of your foot.

Most people who have bunion surgery experience significant pain relief when they recover. The surgery can improve your big toe alignment which can help you walk more easily. Footwear choice can also be an advantage.

The cost of bunion surgery depends on what type of operation you have. The London Podiatry Centre offers different types of surgery and costs will vary. Please call the Centre for more information.

Usually about 3-4 weeks but shoes need to be wide and soft, and trainers are ideal.

Back pain is often the result of bad posture, and bunions are one complaint that can contribute to poor posture. Bunions spread the feet and arch out, which can eventually lead to back pain.

Recurrence is a risk but is generally uncommon because of the way that the position of the bones are corrected.