A bunion is a bony bump that forms on the inside of your foot at the base of your big toe. It develops when the big toe gradually shifts toward the smaller toes, pushing the joint at its base outward. Bunions affect roughly 12% of adults between 20 and 60, and that number climbs to nearly 23% in people over 60.
What Happens Inside the Joint
Your big toe connects to your foot at a joint called the first metatarsophalangeal joint. In a bunion, the long bone behind that joint (the first metatarsal) drifts inward toward the center of your body, while the big toe angles outward toward the smaller toes. This creates the visible bump on the inner edge of your foot, which is actually the head of that displaced metatarsal bone pressing against the skin.
Over time, the forces of walking make this worse. As the metatarsal shifts inward and the toe shifts outward, the ligaments and soft tissue on the inner side of the joint stretch and eventually tear. The joint becomes increasingly unstable, which is why bunions tend to get progressively worse rather than staying the same size.
Symptoms Beyond the Bump
The bony bump itself is the most obvious sign, but bunions cause a range of other problems:
- Pain and stiffness in the big toe, especially when walking or standing
- Swelling and redness around the joint
- Limited range of motion in the big toe, sometimes with a burning sensation when you try to bend it
- Numbness in or around the big toe
- Corns and calluses where the shifted toes rub against each other or against shoes
- Shoe pain that worsens with tight or narrow footwear
For many people, the pain is manageable early on and flares mainly when wearing certain shoes. As the deformity progresses, pain can become constant and affect how you walk, which creates problems elsewhere in the foot and body.
Causes and Risk Factors
Bunions have a strong genetic component. If a parent or sibling has bunions, your risk is significantly higher than the general population. What you inherit isn’t the bunion itself but foot characteristics that make one likely: the shape of your bones, the structure of your arch, and the way your foot moves when you walk.
Tight shoes, high heels, and narrow toe boxes have long been blamed for causing bunions, but the relationship is more nuanced than that. Research suggests poorly fitting shoes probably don’t cause bunions on their own. Instead, they accelerate the process in people who are already susceptible. Someone with a genetic predisposition who wears narrow heels daily will likely develop a bunion sooner and more severely than someone with the same predisposition who wears roomier shoes.
Other risk factors include flat feet, rheumatoid arthritis, and osteoarthritis. Bunions that appear in children and teenagers tend to be more closely linked to inherited joint deformities, while adult-onset bunions are typically driven by a combination of foot mechanics, genetics, and footwear habits over time.
What Happens If You Ignore a Bunion
Bunions don’t resolve on their own, and leaving one untreated allows a chain of secondary problems to develop. Hammertoes are common: as the big toe crowds into the smaller toes, those toes can buckle and become permanently bent. Bursitis, an inflammation of the fluid-filled cushioning sac near the joint, can develop from repeated friction and pressure. Many people also develop metatarsalgia, a painful inflammation in the ball of the foot caused by the shifting weight distribution.
Over the long term, the joint cartilage can deteriorate, leading to arthritis. A severely progressed bunion can also cause enough deformity that surgical correction becomes more complex than it would have been earlier.
Tailor’s Bunion: The Other Kind
Not all bunions form at the big toe. A tailor’s bunion (sometimes called a bunionette) is a similar bony bump that develops at the base of your pinkie toe on the outer edge of your foot. The mechanics are essentially mirrored: the fifth metatarsal shifts outward while the little toe angles inward. These are less common than standard bunions and tend to be smaller, but they cause similar pain and shoe-fitting problems.
Non-Surgical Treatment Options
No brace, insert, or exercise will reverse a bunion completely. The bony deformity is structural, and only surgery can fully correct it. That said, conservative treatments can slow progression, reduce pain, and help many people avoid or delay surgery for years.
Toe separators (small silicone or foam wedges placed between the big and second toe) have the strongest evidence among orthotic options. A systematic review with meta-analysis found that orthoses with a toe separator reduced the bunion angle by roughly 2 to 6 degrees, which is enough to meaningfully relieve pressure and discomfort. Custom-molded toe separators performed better than generic ones, and they also significantly reduced hallux pain. By comparison, night splints and dynamic braces showed a smaller, less consistent effect.
Full-length shoe insoles with arch support help in a different way. Rather than correcting the toe angle directly, they redistribute pressure across the foot, reducing peak pressure under the forefoot by 30% to 40%. This is particularly helpful for people experiencing ball-of-foot pain alongside their bunion. Wider shoes with a roomy toe box reduce friction on the bump and give the toes more space, which can make a noticeable difference in daily comfort. Ice and over-the-counter anti-inflammatory options can manage pain during flare-ups.
One important caveat: research suggests these orthotic benefits tend to provide short-term symptomatic relief. They manage the condition rather than cure it.
When Surgery Becomes the Answer
Surgery is generally considered when pain interferes with daily activities and conservative measures are no longer enough. The specific procedure depends on the severity of the deformity and which structures are involved.
The most common approaches involve osteotomy, where the surgeon cuts and repositions the displaced metatarsal bone to straighten the joint alignment. A chevron osteotomy is one widely used technique, sometimes combined with a second cut in the toe bone (called an Akin osteotomy) for fine-tuning. For more severe bunions, or when the joint at the base of the metatarsal is unstable, a Lapidus procedure fuses that joint to provide a more stable correction. Minimally invasive versions of these surgeries use smaller incisions and are becoming more common.
What Recovery Looks Like
Stitches come out around two weeks after surgery. Bone healing takes six to 12 weeks, during which you’ll wear a protective surgical shoe or boot. Depending on the procedure, you may be able to put some weight on your foot immediately in that boot, or you may need to stay completely off it for several weeks using crutches or a knee scooter.
This distinction matters: putting weight on your foot too early can undo the surgical correction entirely, so following your surgeon’s specific instructions is critical. After the bones heal, you’ll gradually return to normal footwear and full activity. Most people regain normal foot function within three to four months, though some swelling can linger for several months longer.