Bunions are more than just a cosmetic foot issue—they’re a progressive, often painful deformity that can interfere with daily activities, especially for older adults. This common condition affects the metatarsophalangeal (MTP) joint, leading to a noticeable bump on the side of the big toe, often accompanied by pain, difficulty wearing shoes, and even increased fall risk.

A recent review by Andrea S. Aebischer and Samuel Duff offers a clear, clinical overview of bunion management, from conservative care to surgical intervention.

What Causes Bunions?

Bunions, or hallux valgus, typically develop over time due to:
 • Footwear choices (tight or narrow shoes)
 • Genetics
 • Biomechanical issues
 • Arthritis or other inflammatory conditions

They are especially common in older women, but can also appear in adolescents (referred to as juvenile bunions).

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First Line of Defense: Non-Surgical Treatment

For most people, the first step in managing a bunion is non-operative care, including:
 • Accommodative footwear: Wider shoes with a roomy toe box can reduce pressure and pain.
 • NSAIDs: Medications like ibuprofen help manage inflammation and pain.
 •  Orthotics and Braces: Custom inserts or bunion splints may offer relief.
 • Toe spacers: These simple devices can help realign the toes and ease discomfort.

While these approaches often provide symptom relief, they don’t reverse the deformity and may not offer long-term results for all patients.

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When to Refer for Surgery

If conservative measures fail, surgical consultation may be appropriate. According to the review, referral to an orthopedic surgeon is recommended when:
 • The bunion is painful and persistent
 • The patient has tried and exhausted non-operative options
 • The patient is a suitable candidate for surgery

However, cosmetic concerns alone are not a valid reason for surgery. And importantly, smoking is a relative contraindication—patients should quit smoking before pursuing an operation.

For children and teens with juvenile bunions, surgery is usually postponed until after skeletal maturity to avoid complications.

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Takeaway

Bunions are a common foot issue, but they’re manageable—especially when addressed early. While conservative treatments can bring relief, there’s a clear place for surgical intervention in more advanced or symptomatic cases. A patient-centered approach that starts with non-invasive care and transitions to referral when appropriate remains the gold standard.

Bunions: A review of management
Andrea S Aebischer, Samuel Duff

This blog post is purely for informational purposes only and should not replace professional medical advice. It is essential to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan based on your specific condition.