Hallux Valgus
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Hallux valgus, usually called a bunion, is a change at the base of the big toe. The toe leans towards the other toes, and a bony lump forms on the inside of the foot. It is common, and becomes more common with age and in women. The main symptom is pain, often worse when you walk or wear tight shoes, although many people have no pain at all. Wider, softer shoes and simple care can ease symptoms, and many people report improvement once their footwear is sorted. No treatment is known to stop a bunion getting worse.
What is it?
Hallux valgus is the medical name for a bunion. The long bone behind your big toe moves inwards, towards the middle of your body, and the big toe tilts the other way, towards your smaller toes. A bony lump then shows on the inside of the foot, at the big toe joint (where your big toe meets the rest of your foot).
Strictly speaking, "bunion" means the swollen, irritated sac of fluid (a bursa) that can form over the lump. In everyday use, most people and practitioners use "bunion" and "hallux valgus" to mean the same thing.
Who does it affect?
Bunions are common, and they become more common as people get older. Reported rates run from 11 per cent in people under 20 to 35.7 per cent in people over 65.
They affect women more than men. About 23.74 per cent of women have one, compared with 11.43 per cent of men.
Signs and symptoms
The first sign is usually a bony lump on the inside of the big toe joint, with the big toe leaning towards the second toe. The joint can be painful, stiff and swollen. The skin over the lump may be red, swollen or hard.
Pain is usually worse when you walk or wear shoes, and you may find it hard to get comfortable shoes. Some people also get pain along the side or bottom of the foot. Your big toe can rub against, or sit over or under, the other toes.
As a bunion gets worse, the smaller toes can become bent and painful too, especially the second toe.
What causes it?
There is no single proven cause. A bunion is most likely the result of several things working together: the way your foot moves, very flexible joints, the shape of your foot bones, and an imbalance between the muscles and ligaments (the tough bands that hold joints together) in your foot. The tissues on the inside of the big toe joint seem to weaken, which lets the foot bone drift inwards and the toe tilt outwards.
Bunions tend to run in families, and they are more common in women and with increasing age. A longer first foot bone, a rounder head on that bone, and some types of inflammatory joint disease (arthritis caused by inflammation) are also linked to bunions.
Shoes that are narrow, tight or high-heeled are thought to play a part, especially in people who are already at higher risk. Shoes are not a proven cause, and the effect of heel height on its own isn't clear.
How is it diagnosed?
Your podiatrist or GP will usually diagnose a bunion by looking at your foot and asking about your symptoms, your shoes and your family history. They may use an X-ray to measure how far the toe has moved.
They will also think about other causes of a sore big toe joint, such as gout, inflammatory arthritis, a stiff big toe joint (hallux rigidus, which can look similar in older adults) and nerve pain from the back. Gout can only be confirmed for certain by testing fluid taken from the joint.
Treatment
Care usually starts without surgery, and it starts with your shoes. Non-surgical treatments are more likely to ease your pain than to change the angle of your toe, and how well each one works isn't certain.
Looking after it at home
Choose wide-fitting, low-heeled, extra-depth shoes with soft uppers. These make room for your big toe and the lump and reduce the pressure on them. Avoid narrow toe boxes, tight shoes and high heels.
Low-profile bunion pads from a pharmacy may help with rubbing. So may a toe spacer between your big toe and second toe, as long as your shoes are wide enough to take them.
Simple pain relief such as paracetamol or ibuprofen, or an anti-inflammatory cream or gel, can help. Ask your pharmacist or GP what suits you.
For sore spots, hold an ice pack (or a bag of frozen peas) wrapped in a tea towel on the bunion for up to 5 minutes at a time. Don't use ice over numb skin or open wounds, and stop if the pain, swelling or skin soreness gets worse.
Treatment from your podiatrist
Your podiatrist can check your shoes and advise on the right fit. They can also advise on insoles (also called orthoses), toe spacers, toe splints and padding. Insoles may be suggested if your bunion comes with a flat foot, or with a stiff, sore big toe joint. Splints, spacers and padding may reduce rubbing if your shoes are wide enough.
Other options
Some people get less pain from exercises for the foot, hands-on treatment (manual therapy), taping, night splints, and physiotherapy programmes with several parts. It isn't yet known which of these works best.
Surgery
If home care and care from your podiatrist haven't worked, your GP can refer you to a specialist to talk about surgery. The surgeon will check the blood flow, feeling and movement in your foot first.
Recovery
A bunion often gets worse over time, but the speed varies a lot from person to person. Comfortable shoes, pressure-relieving plasters or toe inserts can ease symptoms, but they won't stop the bunion changing. No treatment is known to slow or stop it.
The aim is to keep you comfortable and walking well. Many people report that their symptoms improve once their footwear is right.
Preventing it
No way of stopping a bunion forming or getting worse has been proven. Because tight, narrow and high-heeled shoes may contribute, roomy, low-heeled shoes with soft uppers are a sensible habit and keep your foot more comfortable.
When to see a podiatrist
Book an appointment if
Book an appointment with your podiatrist if your bunion pain hasn't improved after a few weeks of home care, if the bunion is getting worse, if you can't find shoes that are comfortable, or if your smaller toes are becoming bent or painful. If you have diabetes and a bunion, see your GP soon for a review, because foot problems can be more serious with diabetes.
Seek prompt assessment if
Call your local emergency number if you suddenly become short of breath, have chest pain, or cough up blood after foot surgery. If you have a foot wound or infection and you also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number.
See your GP or another doctor today if the skin over your bunion or big toe has spreading redness, warmth, swelling, pus or a fever, which can be signs of infection. See them today too if you have diabetes and a new wound or spreading redness on your foot, or if your calf becomes swollen and painful after foot surgery. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.
See your GP or podiatrist soon if you have an open sore, or skin over the bunion that is broken, blistered or about to break down. See your GP promptly if a sore isn't healing despite care from your podiatrist, if the skin over the joint turns red, hot and swollen and then settles and comes back (this can be gout or another kind of arthritis), or if you have inflammatory arthritis and your foot is becoming more deformed.
Frequently asked questions
Do all bunions need treatment?
No. Many people have a bunion with no pain and need no treatment. Treatment is mainly for pain, rubbing, or trouble finding shoes that fit. If your bunion is quiet, you can leave it alone, but mention it to your podiatrist if it starts to change.
What do the angles on my X-ray mean?
Practitioners often measure two angles: how far the big toe leans (the hallux valgus angle) and the gap between the foot bones behind the big and second toes (the intermetatarsal angle). The cut-offs for what counts as abnormal differ between practitioners, so ask your podiatrist what your measurements mean for you.
Can I have bunion surgery if I have diabetes?
Diabetes on its own isn't a reason to avoid bunion surgery. The main reason surgery may not be suitable is poor blood flow in the arteries of the leg and foot. Your surgeon or doctor can tell you whether surgery is right for you.