Bunion Pain (Hallux Valgus)

Overview

A bunion (hallux valgus) is a change in the alignment of the big toe joint. The big toe gradually angles toward the second toe while the joint at its base pushes outward, creating the familiar bump on the inner side of the foot. The bump itself is not new bone growing — it is the joint becoming more prominent as the toe drifts.

Bunions develop slowly over years and are very common, particularly in women and in people over 40. Many people have a bunion with no pain at all. Problems arise when the bump rubs on shoes, the joint becomes stiff and sore, the skin becomes inflamed, or the altered toe position starts to overload the second toe and the ball of the foot.

We want to be clear about what we offer: surgery is the only way to change the angle of the toe, and we do not provide it. What conservative care can do is reduce pain, improve how the foot moves and functions, slow down the problems that come with a bunion, and help you decide whether a surgical opinion is worth seeking. For many people this is enough to stay active and comfortable.

Causes and risk factors

• Family history — foot shape and joint laxity are strongly inherited
• Narrow, pointed or high-heeled shoes that push the big toe inward
• Flat feet or overpronation, which increase strain on the big toe joint
• Joint hypermobility
• Inflammatory arthritis affecting the foot
• Being female and over 40
• Jobs or activities involving long periods on your feet

How we may be able to help

Assessment first. We examine the big toe joint's movement and stiffness, look for inflammation over the bump, check the second toe and the ball of the foot for overload, and assess your overall foot posture and walking pattern. If the joint is very inflamed or you want to explore a surgical opinion, we can arrange an online private GP consultation for referral.

Our 3D foot scan measures how the foot loads and how much the arch is contributing. Custom orthotics can be designed to support the arch, reduce the inward rolling that pushes on the big toe joint, and spread pressure away from sore areas under the forefoot. Many people with painful bunions find this improves day-to-day comfort in sensible shoes.

Physiotherapy focuses on keeping the big toe joint mobile with manual therapy, strengthening the muscles that stabilise the toe and arch, and improving how you push off when walking so that load is shared more evenly. Kinesiology taping can gently encourage a better toe position and reduce rubbing during the day. Therapeutic ultrasound may be used as an adjunct when the soft tissue over the bump is inflamed. For a stiff, painful big toe joint that has not settled with these measures, a joint injection is a recognised option; whether it is appropriate is decided with a doctor after assessment.

What you can do at home

• Wear shoes with a wide, deep toe box and soft upper; avoid pointed toes and heels above about 4 cm
• Use a gel bunion pad or sleeve to reduce rubbing on the bump
• Gently move the big toe through its full range each day to keep it mobile
• Practise toe-spreading and "short foot" exercises to strengthen the arch
• Apply a wrapped ice pack for 10 minutes if the bump is red and sore after a long day
• Consider a toe spacer at night if it is comfortable — it will not change the angle but may ease symptoms