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Health condition · Clinically reviewed

Bunions, from wider shoes to modern keyhole surgery.

Bunions are progressive, but they are not inevitable pain. A clear plan, from footwear and orthotics to well chosen surgery, gives most people a comfortable foot again.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BOFAS, NICE and peer-reviewed foot and ankle sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK foot and ankle practice including scarf, lapidus, lapiplasty and minimally invasive bunion surgery.

Key facts

Bunions at a glance.

The essentials, in plain English. What a bunion actually is, who tends to get one and how it is treated in the UK today.

  • What it is

    Hallux valgus, a progressive deformity of the great toe with lateral deviation of the hallux, medial deviation of the first metatarsal and a prominent medial bump.

  • Who gets it

    Around ten times more common in women, with strong genetic and footwear links and a rising prevalence with age.

  • Severity

    Graded mild (HV angle under 20 degrees), moderate (20 to 40) or severe (over 40) using weight bearing x-rays.

  • Associated problems

    Crossover second toe, hammer and claw toes, metatarsalgia, bursitis and coexisting hallux rigidus arthritis.

  • First line care

    Wider footwear, orthotics, toe spacers, activity modification and simple analgesia. Splints will not reverse the deformity.

  • When to operate

    Painful bunions that fail conservative care, or those causing secondary lesser toe deformity, benefit from surgical correction.

Why this guide matters

A stepped plan, not a splint and hope.

Bunions are progressive, and the internet is full of quick fixes that will not work. The three points below shape the rest of this page.

  • Splints do not straighten bunions

    Correctors can ease symptoms but there is no good evidence they reverse an established hallux valgus deformity.

  • Footwear does much of the heavy lifting

    A wide toe box and a low heel, worn consistently, often does more than any product bought online.

  • Surgery is powerful when it is time

    Modern osteotomies, lapiplasty and minimally invasive techniques mean well selected surgery is highly effective.

How the diagnosis is made

From painful bump to a clear plan.

The steps a UK GP, podiatrist or foot and ankle surgeon will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Foot examination

    Inspection, palpation, range of motion at the first MTP joint, gait, subtalar joint, medial arch, posterior tibial tendon and second toe alignment.

  2. 02

    Assessing

    Neurovascular and skin check

    Pulses, sensation, capillary refill and skin over the bump. Important in diabetic feet where ulceration risk is higher.

  3. 03

    Assessing

    Footwear and biomechanics

    A look at everyday shoes, arch profile, hypermobility and any tight Achilles that may be feeding the deformity.

  4. 04

    Confirming

    Weight bearing x-rays

    Standing AP and lateral views measure the HV angle, intermetatarsal angle, distal metatarsal articular angle, sesamoid position and any arthritis.

  5. 05

    Confirming

    Selective CT or MRI

    Reserved for suspected arthritis, avascular necrosis, soft tissue problems or complex preoperative planning.

  6. 06

    Planning

    Exclude other causes of pain

    Inflammatory arthritis, gout, gouty tophus and, rarely, septic joint are ruled out where the story does not quite fit.

  7. 07

    Planning

    Shared surgical planning

    If surgery is on the table, the deformity grade, joint quality and activity goals guide the chosen osteotomy or fusion.

Typical timeline: a first visit to a settled plan in a few weeks, and to surgery when needed within a few months.

Symptoms

What a bunion actually feels like.

The visible bump is only part of the picture. Pain, stiffness, bursitis and lesser toe deformity all come into play as the joint changes.

  • Medial bump

    A visible prominence at the base of the great toe, often reddened where footwear rubs.

  • Pain over the bunion

    Aching or burning pain, worse in narrow shoes and at the end of long days on the feet.

  • Bursitis and skin callus

    An inflamed bursa and thickened skin over the bump, sometimes tender and warm.

  • Stiff or arthritic first MTP

    Reduced range of motion, deep joint pain and a co-existing hallux rigidus in more advanced cases.

  • Secondary lesser toe deformity

    Crossover second toe, hammer or claw toes and metatarsalgia as the great toe pushes into its neighbours.

  • Footwear intolerance

    Struggling to find comfortable shoes, sometimes needing wide or bespoke fits to get through the day.

  • Sesamoid subluxation

    Shift of the small sesamoid bones under the first metatarsal, seen on x-ray and contributing to pain.

  • Red flag, ulceration or infection

    Any break in the skin over a bunion, especially in diabetes or poor circulation, needs same day review.

Treatment

How bunions are treated in the UK.

Footwear, orthotics and simple analgesia first. Osteotomy, lapidus, lapiplasty and minimally invasive surgery when pain and deformity call for correction.

  • Footwear change

    Wide toe box, soft leather, low heel and no pointed shoes. Often the single most useful intervention early on.

  • Orthotics and pads

    Custom insoles for flat foot or arch support, plus bunion pads, shields and toe spacers to offload the joint.

  • Analgesia and activity change

    Paracetamol, oral or topical NSAIDs, ice and pacing high impact activity to keep flares under control.

  • Night splints and correctors

    Comfort aids that may ease symptoms, but the evidence does not support them reversing an established deformity.

  • Physiotherapy

    Intrinsic foot strengthening, calf and Achilles stretching and gait retraining to protect the joint.

  • Steroid injection

    Selective use for painful bursitis or first MTP arthritis, delivered by an experienced clinician.

  • Osteotomy surgery

    Chevron, scarf or Akin cuts realign the first metatarsal and phalanx. Choice depends on the deformity grade.

  • Lapidus, lapiplasty or fusion

    First tarsometatarsal fusion, 3D lapiplasty correction or first MTP arthrodesis for severe, hypermobile or arthritic feet.

Deep dives on the surgical options

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, podiatrist or foot and ankle surgeon knows your foot and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Orthopaedic Foot and Ankle Society (BOFAS). Patient information on hallux valgus.

  • NICE Clinical Knowledge Summaries. Bunions (hallux valgus).

  • Royal College of Surgeons of England. Commissioning guide: painful deformed great toe.

  • AOFAS. Position statements on hallux valgus and minimally invasive bunion surgery.

Red flags

When a bunion needs urgent attention.

Most bunions are managed in primary care and elective foot and ankle clinics. These are the situations that need a faster response.

  • Skin ulceration over the bump

    Any break in the skin over a bunion needs prompt review, particularly in diabetes or peripheral vascular disease.

  • Suspected infection

    Spreading redness, warmth, discharge or fever means same day medical assessment and possible antibiotics.

  • Acute red hot painful joint

    A very tender, swollen first MTP with fever raises septic arthritis or gout. Do not wait to be seen.

  • Loss of sensation or pulses

    Numbness, cold toes or absent pulses point to a neurovascular problem needing urgent vascular or diabetic foot review.

  • Rapidly progressive deformity

    A bunion that worsens quickly, especially with other joint pain, may signal inflammatory arthritis and deserves rheumatology input.

  • Charcot foot suspicion

    A hot, swollen, deformed foot in a person with diabetes is Charcot until proven otherwise. This is an emergency.

  • Post-operative concern

    New severe pain, calf swelling, breathlessness or wound problems after bunion surgery need urgent contact with the surgical team.

  • Suspected DVT after surgery

    Calf pain and swelling after foot surgery should be reviewed the same day for deep vein thrombosis.

  • CRPS features

    Burning pain, colour change and hypersensitivity out of proportion to the injury need early specialist assessment.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day. Footwear, load management, foot strength and knowing when to escalate.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for months do far more than a heroic week that does not last.

  1. 01 Footwear

    Pick shoes that fit the foot

    Wide toe box, soft uppers and a low heel. The foot should shape the shoe, not the other way round.

  2. 02 Load

    Pace impact and standing

    Break up long days on your feet, use cushioned insoles and give the joint time to settle after flares.

  3. 03 Strength

    Keep the foot strong

    Simple intrinsic foot exercises and calf stretches help the joint tolerate everyday load.

  4. 04 Timing

    Do not wait for a crisis

    If pain is limiting life, or the toe is crowding its neighbours, ask for a foot and ankle opinion sooner rather than later.

Frequently asked

Everything we get asked about bunions.

Quick answers on causes, non-operative care, surgical options and recovery.

  • What causes bunions?

    Bunions are a progressive deformity of the great toe with lateral deviation of the hallux and medial deviation of the first metatarsal. Genetics is the strongest driver, with footwear, hypermobility, flat foot and inflammatory arthritis all playing a part.

  • Can I fix a bunion without surgery?

    Conservative care with wider footwear, orthotics, toe spacers, physiotherapy and simple analgesia can control pain and slow symptoms, but it will not straighten an established deformity. Splints and correctors do not reverse hallux valgus.

  • When should I consider bunion surgery?

    Surgery is considered for painful bunions that have not responded to conservative care, for progressive deformity, and where lesser toes are being pushed out of place. The decision is shared, based on pain, function and imaging.

  • What operations are used for bunions?

    Options include distal osteotomies such as chevron, scarf osteotomy of the first metatarsal, akin osteotomy of the phalanx, lapidus first tarsometatarsal fusion, 3D lapiplasty correction, first MTP arthrodesis for severe arthritis and minimally invasive keyhole techniques such as MICA or PECA.

  • How long is recovery after bunion surgery?

    Most people wear a surgical shoe or CAM boot for six to eight weeks with weight bearing guided by the surgeon. Return to trainers is usually around two to three months, with swelling and full recovery taking six to twelve months.

  • What are the risks of bunion surgery?

    Recognised risks include recurrence, malunion, avascular necrosis, hallux varus, transfer metatarsalgia, wound problems, infection, deep vein thrombosis, nerve injury and complex regional pain syndrome. A foot and ankle surgeon will discuss the balance for your foot.

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