A bunion or hallux valgus is a bony lump that appears at the bottom of the big toe, causing the toe to bend inwards. This lump is created by the effect of the metatarsal bone, the protruding bone, rubbing against the shoe. Its Latin name, hallux valgus, derives from ‘hallux’ for ‘big toe’ and ‘valgus’ which translates as ‘pointing outwards’. Another variant, affecting the small toe, is known as the Tailor’s bunion.

Although tight or pointed shoes can aggravate a bunion, the underlying cause is usually the mechanics of the foot, which is why bunions often run in families and tend to enlarge slowly over time. As the big toe drifts, it crowds the lesser toes and the bump rubs in shoes — the common symptoms are pain over the prominence, difficulty finding comfortable footwear, and sometimes problems developing in the second toe.

For symptoms, roomier footwear, toe spacers and orthotics can all help and are a perfectly reasonable first step — but they manage the discomfort rather than reverse the deformity. When a bunion is genuinely painful or stopping you wearing normal shoes, surgery realigns the bone (an osteotomy), usually held with small screws, to bring the big toe back into position.

Modern bunion surgery, including minimally invasive techniques, is reliable and well tolerated, with most patients walking in a special shoe soon afterwards. The right approach depends on the size of the deformity and the state of the joint, which a weight-bearing X-ray will show.