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Understanding Bunions

Stephen F. Conti, MD

Often patients have misconceptions about bunions. Many individuals believe that the bony lump sticking out from their foot is just extra bone. But in fact, a bunion is actually an angular deformity of the joint at the base of the great toe.

There are many factors to consider about this common but potentially serious foot condition.

Medicine has come a long way, particularly in understanding the problems associated with bunions. Bunions were once thought to be primarily cosmetic deformities that may, for example, cause difficulty fitting into a narrow shoe.

Bunions are now known as significant deformities at the big toe joint that can result in progressive arthritis.

For biomechanical reasons, a bunion can also cause stress on the second and third toes, leading to additional deformities as well as joint arthritis in the arch.

Types of Bunions

There are two types of bunions:

  • Congenital
  • Acquired

Congenital bunions are inherited, and often noticed by the patient in their teenage years. This is simply caused by genetics and the way bones form in the foot. Congenital bunions are often non-progressive, but still may become arthritic with time. A congenital bunion that is painless should be supported with an appropriately fitting shoe, and occasionally supplemented by the use of orthotics.

The second type is an acquired bunion, which is typically developed over time, even though the patient was born with a straight toe. This often occurs in women over the age of 40. Acquired bunions are progressive and often result in a much more serious arthritis than the congenital type.

Treatment of Bunions

Acquired bunions are best treated with surgery to realign the toe. This is done through an operation that realigns the joint. It also realigns the arthritic bones and puts them back to their proper positions, which help slow the progressions of arthritis. The results of surgery will be improved if the bunion is treated before the joint become arthritic.

Once there is no longer any cartilage on the joint surfaces, realigning the toe will only provide a cosmetic improvement, but not a decrease in pain. This is why early detection and treatment of acquired bunions is extremely important.

As our knowledge of bunions progresses, surgical techniques to correct the deformity are improving as well. More effective correction with earlier healing times are now possible in ways that were unavailable in the past.


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