Bunions: Diagnosis, Cause and Treatment

Bunion Present on The big Toe Joint

What Causes Bunions

A Bunion is a common foot complaint, which involves the big toe joint slowly deviating from its natural position. The condition will typically present as a bony bump below the base of the big toe that protrudes outwards from the foot.

Bunion symptoms include:

  • A bulging bump below the big toe
  • Swelling, redness or soreness around the joint of the big toe
  • Corns or calluses, which often arise due to overlapping toes
  • Pain, either continuously or intermittently
  • If arthritis affects the toe, this may limit movement of the joint

The precise causes are unknown, but Bunions are thought to be due to:

  • Pressure or stress on the foot, either from tight fitting footwear or a medical condition
  • Inherited predisposition; if your parents have Bunions you are more likely to develop one
  • Arthritis, which causes damage to the joint cartilage and can give rise to a Bunion

How Do You Get Bunions

Bunions often develop over a long period. They are progressive, meaning that without intervention a Bunion will get worse over time. A Bunion will typically first appear as a mild bump below the big toe that protrudes out from the foot. As it develops the bony bump may become more severe, causing irritation in footwear, redness and inflammation. As the joint deviates further, the big toe may start to underride or overlap the adjacent toes, causing further issues and painful symptoms.

There are many basic ways of conservatively treating Bunions, often these aim to relieve painful symptoms and prevent the Bunion from progressing.

Comfortable Shoes For Bunions

Tight fitting shoes can aggravate Bunion symptoms. Rubbing and pressure from the shoes may lead to crowding of the toes, as well as corns and calluses. Shoes with narrow toe boxes, such as high heels, can make the Bunion deformity worse.
A sensible first course of action will be to use shoes with wide toe boxes, so as to avoid exacerbating painful symptoms or fast progression of the condition.

Bunion Toe Straightener

Bunion toe straighteners are a conservative treatment option that may be helpful in reducing painful-symptoms. These devices work by separating the big toe from the other toes and cushioning the bony Bunion bump to prevent irritation. There is no medical evidence to suggest these devices will resolve Bunion complaints, but they can be a useful way to relieve symptoms and prevent progression of the condition.

Can Bunions Be Fixed Without Surgery

Understandably, many people prefer to avoid surgical treatments. Conservative treatments are almost always recommended in the first instance, and simple measures such as wearing sensible shoes or using pain-relieving splinting devices can help manage the condition. However, Bunions are progressive and will inevitably get worse over time. Surgery is currently the only treatment option for fully resolving a Bunion complaint.

Types Of Bunion Surgery

There are many types of Bunion surgery. Some surgeons may favour particular surgical techniques that they find effective and some procedures are more suitable for particular cases. The three most common types of operation are:

  1. Traditional Bunionectomy – A Bunionectomy involves removal of the enlarged lump at the big toe joint. The surgeon may correct the tendon or ligament balance that initially gave rise to the Bunion in order to improve alignment. This procedure is generally recommended for very minor Bunion deformities in elderly patients where the bony bump is the main problem and the alignment operation is not advisable.
  2. Scarf & Akin Osteotomy – The Scarf & Akin procedure is used to treat moderate Bunion deformities. It allows for fast weight-bearing due to the stability of the specialised bone cutting techniques and titanium screws, which are used to correct the bone alignment. This is one of the most popular forms of Bunion operation globally.
  3. Lapidus Fusion Procedure – The Lapidus procedure aims to correct two bones near the arch of the foot, which because of their flexibility have lead to the Bunion developing. The Lapidus procedure is generally recommended for patients who have painful moderate to severe Bunion deformities, often when the Bunion is associated with hypermobility.


Removing Screws After Bunion Surgery

Often surgical screws are used to keep realigned bone in place after the operation. Normally these will stay in place permanently, as they are benign and are thought not to warrant further surgery in order to remove them. However, in the minority of cases the screws can become irritating or cause swelling in the area and in such cases the screws may be removed once the bone has healed.

What Is The Best Surgery For Bunions?

There is no ‘Best’ surgery for Bunions. Surgical techniques develop over time, as new treatments are discovered and improved, or technology advances. A surgeon will usually be aware of many procedural options to treat a Bunion, but they will often advise on a particular surgery that is suited to the patient. A surgeon will often provide detailed information on the operation that they recommend so that an informed decision can be made by the patient.

What Is Minimally Invasive Bunion Surgery?

Minimally Invasive surgery makes use of techniques that reduce the number and size of incisions required to resolve the Bunion. This has the benefit of lessening tissue damage and scarring following the procedure.There are a range of Minimally Invasive techniques, sometimes these are developed or performed only by specific surgeons.

How Much Does Minimally Invasive Bunion Surgery Cost?

If you are self funding, the cost of Bunion surgery will vary depending on a number of factors, such as location, type of anesthetic, your age, whether the surgery is for one foot or both etc. However, on average surgical correction of Bunions in London would cost between £5000-£9000. Below is a breakdown of fees charged at The London Foot & Ankle Surgery.
Unilateral (ONE FOOT) Bunion Surgery

Preoperative Fees
Initial Consultation £200
X-ray Imaging £125
Surgeon and Facility Fee £3550
2-3 Surgical Screws (each screw is £175) £350-£525
General Anesthesia – Preoperative Assessment £150 for under 60s
£240 for over 60s
Anesthetist Fee £300
Crutches £60
Postoperative Shoe £20
Dressing Change £50
Physiotherapy – Typically six sessions are required £300 Package Fee
Postoperative X-ray Imaging £125
TOTAL £5495 (Approximate)

Bilateral (Both Feet) Bunion Surgery

Preoperative Fees
Initial Consultation £200
X-ray Imaging £250
Surgeon and Facility Fee £5325
4-6 Surgical Screws (each screw is £175) £525-£1050
General Anesthesia – Preoperative Assessment £150 for under 60s
£240 for over 60s
Anesthetist Fee £400
Crutches £60
Postoperative Shoe x2 £40
Dressing Change £100
Physiotherapy – Typically four sessions are required £300 Package Fee
Postoperative X-ray Imaging £250
TOTAL £8215 (Approximate)


Bunion Surgery Before And After

It can be helpful for those who are considering surgical options to compare the condition before and after surgery. Surgeons will often provide details of the differences a patient could expect, particular areas of improvement and aims of the surgery. They may also provide pictures to showcase the successfulness of their surgical techniques in past cases.

What To Expect After Bunion Surgery

Bunion surgery is often very successful and can fully resolve the condition. With minimally invasive techniques you can expect little scarring, generally you can expect improved cosmetic appearance and symptom-free improved functioning of the foot.

Bunion Surgery Recovery Time

Recovery from Bunion surgery normally takes roughly six to eight weeks, although full recovery can take four to six months on average.

Bunion Surgery Recovery Tips

Your surgeon will provide clear advice on how to make the best recovery following a Bunion procedure. Some generally useful advice would include:

  • Keep off your feet as much as you can
  • Ice your foot and toe to speed healing and reduce inflammation
  • Take pain-killers to manage the pain


How To Prevent Bunions

If you suspect that you are developing a Bunion then preventative measures are essential to avoid reaching the severe and painful stages that require surgical intervention. This is particularly true for people who have a family history of Bunion. Helpful preventative measures include:

  • Wear sensible shoes that fit properly
  • Avoid wearing high heels or pointed shoes
  • Exercise your feet regularly, this may include simple regimes like learning to pick up a pencil with your toes
  • Keep track of your foot shape, it may be helpful to draw an outline periodically to see if they are changing shape