The Foot Mechanix Blog

I Think I’ve Got A Bunion...

Thursday, February 25, 2016

This is something many of my patients say when they come to see me, so I thought it would be a good idea to clarify what a bunion actually is and what the condition is that many people have, that they mistake for being a bunion.

A bunion or ‘Hallux Abducto-Valgus’, is something that happens in your forefoot. The bone behind your big toe, called the 1st metatarsal, starts to move medially. If it were your right big toe, this means it moves to the left. The big toe starts to move towards the 2nd toe, again if it were your right big toe, it moves to the right. The lump that you see is the head of the metatarsal bone and it is on the inside of your foot. The bunion takes its name from the Latin word for turnip (bunio), thereby suggesting a rounded, hard-skinned, and sometimes purple-coloured swelling. That is more or less how a bunion appears – an inflamed swelling of the main big-toe joint where it meets the mid-foot.


Bunions can be caused by a number of things and there is no one specific cause. Common misconceptions are that footwear causes them, but whilst footwear can contribute to the formation of a bunion, it is not the root cause. Bunions have been found even in barefoot tribes. We all inherit a foot structure from one or other of our parents and this, together with biomechanical abnormalities in the way your foot functions is a major factor in bunion formation. People often think they’ve inherited a bunion, but what they have inherited is a foot structure that predisposes to a bunion formation. Other factors then can contribute, such as foot-wear, over-pronation and pregnancy or hormonal changes which cause the ligaments that hold the foot together to become lax.

And often what patients have that they think is a bunion, is a thickening of the head of the 1st metatarsal due to osteoarthritic changes. Osteoarthritis is a wear and tear arthritis that happens when one bone rubs against another, it causes the bone to grow extra bits, often referred to as osteophytes or exostoses. The most common reason for this to occur is due to what is known as a Functional Hallux Limitus. The Hallux is the name for the 1st toe, Functional Limitus means that it is being limited in it’s available flexion when you push off during walking or running. Usually this functional limitus is caused by overpronation, i.e your foot is rolling inwards causing the arch to lower and therefore more pressure under the big toe joint. Basically, the big toe bone, which is the proximal Phalanx, jams against the head of the 1st metatarsal. This over time starts to wear the cartilage between the 2 bones away. Eventually the 2 bone surfaces touch and rub against each other, which causes the extra bone formation/thickening.

The positive thing is that both a bunion and a Functional Hallux Limitus can be treated and respond well to the use of functional orthoses worn within your shoes. Exercises and mobilisation may also be recommended in conjunction with the orthoses. These conservative methods can alleviate pain and slow the progression of the deformity down.

Sometimes surgical intervention is necessary, but orthoses are still recommended post surgery to maintain the surgeons work and help prevent recurrence.

If you are concerned you are developing a bunion, or have pain in your big toe joint which may be due to a Functional Hallux Limitus, contact Foot Mechanix Podiatry on 01932 353568