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What's A Bunion and Why Should I Care?

Posted by Douglas W. Stoddard MD, M Sp Med, Dip Sport Med, ES on 27 May 2015
What's A Bunion and Why Should I Care?

Bunions, Not Onions

It may rhyme with onions, but it's definitely no foodstuff. What exactly is a bunion, and why should you care?

Well, stay on your toes; we'll enlighten you.

To put it simply, a bunion is a lateral deviation of the large toe. To put it in jargon for the sake of jargon, the correct term for it is the Hallux Valgus, which indicates that the hallux (big toe) has an abnormal position in which it leans towards the smaller toes. The deformity may involve the the first metatarsal phalangeal joint (large toe joint), the sesamoids (the two small bones below the joint), and the surrounding soft tissue.

And yes, it looks, and feels, painful. Not the most ideal combination to put on a platter. 


In the past, improper shoes were considered to be the primary cause of a bunion deformity (we were looking at you, killer-heelers!). However, this has been proven to be false by the statistical fact that many people who have never worn shoes have developed a Bunion, while many who've worn poorly designed or fitting shoes have not.

With advancements in the science of foot biomechanics, the following factors have most often been identified in the formation of a bunion:

  • Hypermobility of the forefoot - your joints are able to easily move into ways they shouldn't
  • Rheumatoid arthritis - Inflammation in the joints that cause painful deformity and immobility 
  • Neuromuscular disease - a disease that interferes with the nerves that control your muscles
  • Post-surgical malfunction - negative aftereffects, possibly due of a previous surgical procedure

Of these, forefoot hypermobility, which is the result of genetic predisposition, is the most common. This excessive motion, combined with excessive pronation from the rearfoot segments, will cause a bunion to develop.

Symptoms and Development

The bunion is a progressive deformity, which means it's something that becomes more apparent in time. The rate of progression is dependent on the degree of hypermobility and how far your foot rolls inward during movement. So finding the appropriate treatment is no easy task, because there's so many variables to pin-pointing its symptoms and developmental stages.

But here are some general symptoms and development to give you a clearer picture of what you're dealing with:

In the early stages of bunion development, the protruding joint, or of the toe itself, begins to swell. And don't worry, you'll most likely notice it happening. The area usually becomes red, and pain commonly occurs. The pain is typically the result of ligament strains and/or muscle spasms. But unfortunately, there are cases when it's not so simple. That's why bunions are such a bugger to get down!

In the middle stages, the large toe may overlap or underlap the adjacent toe. Pain is more consistent and is often intensified by certain shoes that increase pressure on the joint.

In the late stages, the large toe may become non-functional, and the weight bearing normally associated with this part of the foot shifts to other segments of the forefoot.


The most effective treatment of bunions in the early stages is achieved by the use of what's called functional biomechanical orthotics.

This type of control will basically stop the strain of the foot muscles, and more importantly, slow down the rate in which the deformity progresses. Massage therapy can also be applied to help alleviate the soft tissue symptoms, and physiotherapy may be of some use in minimizing joint stiffness, especially in the early stages.

In the most advanced stages, surgery may be indicated to re-align the deformed segments of the forefoot.

But once again, it's not so simple. Not all surgical results are positive, so more conservative measures should be given a fair trial first.

Post-operatively, functional orthotics will help restore elements of normal foot function that the surgery doesn't cover. This is important, because if excessive pronation with continued irregular movement of your joints is allowed to continue after procedure, there's a pretty good chance of the dreaded post-operative pain and...

the bunion coming back to haunt you once more. Yikes.

Even though the overpronation of the foot may be totally neutralized with orthotics, if the underlying cause of the bunion is not neutralized by the use of orthotics or surgery, the bunion is, once again, likely to redevelop.

Think You've Got Bunions?

If you are suffering from a painful bunion, or if you think you may have the early stages of development, the team of professionals at SEMI is available to assess your condition and offer a wide array of treatments. To learn more about what we can do for you, contact us today!


Robert Warner  DPM
Sport Podiatrist  Printed: March 2004
Copyright ©2004 SEMI

Author: Douglas W. Stoddard MD, M Sp Med, Dip Sport Med, ES
About: Dr. Douglas Stoddard is a sports medicine physician and is the Medical Director of the Sports & Exercise Medicine Institute (SEMI). After receiving his medical degree from the University of Toronto, he trained in Australia at the Australian Institute of Sport in Canberra, obtaining his Master Degree in Sports Medicine. He is also a diplomat of the Canadian Academy of Sport and Exercise Medicine and has his focussed practice designation in Sport Medicine from the Ontario Medical Association. Dr. Stoddard is a consultant to the Canadian Military and has consulted with well over 30,000 unique patients in his career. Dr. Stoddard is constantly searching for new and promising therapies to help SEMI patients, and is responsible for developing the RegenerVate Medical Injection Therapy Program. He is married and the proud father of two boys, is an avid triathlete and occasional guitar player.
Tags: Lower body Treatment options


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