When Do Bunions Require Surgery?

Your big toe contains two joints. The larger one is the metatarsophalangeal joint (MTP). The base of this joint is where bunions form. The bony bump is actually a misalignment of the bones in the foot, where the metatarsal bone shifts outwards and the toe angles inward.

Board-certified podiatrist Albert Nejat, DPM, FACFAS, at the Podiatry Institute of Southern California in Culver City, California, has extensive experience diagnosing and treating all types of foot, toe, and ankle problems, including bunions.

Here’s what Dr. Nejat wants you to know about bunions and whether yours might require surgery.

Bunion basics

Bunions, or hallux valgus, develop over a long period, usually from compressing the toes together. That weakens the ligaments that hold the toe in a straight position, and the big toe tilts toward the second toe.

Along with the tilt, the shifting toes cause the bones to move out of alignment, creating a bulge at the MTP joint — a bunion. The bump can become red, swollen, and painful as it grows, making it hard to find shoes that fit or, in severe cases, even to walk.

An estimated 1 in 5 Americans has some degree of bunion formation. The deformity is far more common in women than in men, possibly due to women often having weaker tendons and ligaments in their feet and being more likely to wear tight shoes with high heels. Bunions are also more common in people over the age of 40.

Smaller bunions that develop on the base joint of your little toe are called tailor’s bunions.

What causes bunions?

Aside from the stress placed on the MTP joint, researchers aren’t exactly sure what causes bunions. However, it’s likely a combination of the following:

• Genetics
• Foot injuries
• Arthritis inflammation
• Abnormal bone structure (congenital)
• Flat feet
• Excessively flexible ligaments

Shoes with a too-narrow toe box or high-heeled shoes may also cause or exacerbate the problem.

Bunion symptoms and complications 

Other than the telltale bump at the base of the big toe, bunion symptoms include:

• Inflamed skin over the bump
• The big toe leans toward your other toes
• Thickened skin on the bottom of the big toe
• Corns or calluses on the second toe
• Intermittent or persistent foot pain
• Decreased range of motion in the big toe

Bunions can also cause complications. The displaced joint can irritate the bursa, the fluid-filled sac that cushions the joint. In response, the sac becomes inflamed and swollen, limiting movement in the other toe joints. This condition is called bursitis.

Another complication is hammertoe. When the big toe pushes against the second toe, it can slip beneath it and cause an abnormal bend in the middle joint of the second toe. Along with the pain of the joint rubbing against your shoe, you may develop calluses on the joint or even open sores.

A third bunion complication is metatarsalgia, where the pain and swelling manifest in the ball of your foot due to walking awkwardly, trying to avoid the pain of the bunion.

When do bunions require surgery?

Dr. Nejat always starts with conservative options when treating bunions. That may include one or more of the following:

• Bunion pads
• Foot taping
• Custom orthotics 
• Over-the-counter anti-inflammatories to resolve mild pain 

Physical therapy may be recommended to help strengthen the foot joints and tendons and prevent other podiatric issues. If you’re in too much pain to do PT, a steroid injection into the joint can temporarily relieve pain, allowing you to do the exercises.

If the MTP joint becomes significantly deformed, though, surgery may be the best option to relieve pain and restore function. There are many procedures, some that remove swollen tissue around the joint, some that realign the bones, and some that remove a portion of bone tissue.

Dr. Nejat is skilled in multiple bunionectomy procedures and tailors his approach to your needs. If you’re battling bunions, call the Podiatry Institute of Southern California at 310-204-2300 or schedule an appointment online.