You may have noticed a bony bump forming on the side of your big toe. Known as a bunion, or hallux valgus, this condition often signals a structural imbalance in your foot. Although it may initially appear harmless, a bunion can gradually impact your foot’s natural movement and add strain to nearby areas. Over time, inflammation from this misalignment can lead to persistent pain, making daily activities like walking or even standing feel challenging.
But bunions aren’t the only culprits. A similar issue, called a bunionette or Tailor’s Bunion, can develop on the outside edge of the foot, near the base of the little toe. Both bunions and bunionettes often start with a mild ache around the affected joint, which can intensify as inflammation progresses. It’s also possible that other conditions might be causing similar pain, so if you’re unsure, it’s worth exploring the causes further to understand what may be affecting your foot health. Here, we look closely at the factors contributing to bunion and bunionette pain and the options available for managing it.
Causes of Bunions & Bunionettes
Bunions and bunionettes don’t just appear overnight. Instead, they form gradually as ongoing pressure impacts the joints of the big and little toes over time. In the case of bunions, this pressure pushes the big toe toward the second toe, creating a visible bump on the side of the foot near the big toe joint. Similarly, when this pressure affects the little toe, a bunionette can develop along the outer edge of the foot, at the base of the small toe.
Some factors that may contribute to the formation of bunions and bunionettes include:
- Foot Shape: Certain foot structures, such as abnormal bone alignment, flat feet, low arches, or loose joints, can increase the risk of developing bunions or bunionettes. These shapes may allow the toe joints to shift out of alignment more readily, which may lead to joint misalignment and discomfort.
- Poor Fitting Shoes: Wearing shoes that are too tight, narrow, high-heeled, or pointy-toed places added strain on both the big and little toe joints. This type of footwear can accelerate the formation of bunions or bunionettes by continuously pressing the toes into restrictive positions.
- Genetics: Since foot shape and structure are often hereditary, a family history of bunions or bunionettes can make it more likely for an individual to develop these conditions. People with a genetic predisposition may experience these issues earlier or more severely than others.
- Medical Conditions: Rheumatoid arthritis and past foot injuries can also play a role in bunion and bunionette formation. These factors may impact joint stability and alignment, contributing to conditions that allow the toes to shift and add pressure on the joints.
- Physical Activities: Sports that require tight or restrictive footwear, like football, cycling, or ballet, can place excessive pressure on the toe joints. Narrow footwear like football boots, cycling cleats, and pointe shoes limits toe movement, which over time can contribute to bunions and bunionettes.
Symptoms of Bunion & Bunionettes
Bunions and bunionettes can lead to noticeable discomfort that might worsen into pain, often interfering with daily activities. Symptoms usually start with a visible bump and can progress to additional issues over time.
Bunions
A bunion appears as a distinct bony bump at the first metatarsophalangeal (MTP) joint, where the big toe meets the first metatarsal bone. This bump is often visible and can be felt easily. Bunions can lead to stiffness or discomfort in the big toe joint, which may progress into aching or throbbing pain, especially during movement or when bending the toe. Swelling around the joint is common, often accompanied by redness due to inflammation in the area.
Footwear that is tight or narrow can increase friction against the bunion, worsening symptoms. This friction may also cause corns or calluses on the skin near the affected area. Bunions can sometimes cause hammer toes, where the second, third, or fourth toe bends at the middle joint in a hammer-like shape.
Bunionettes
A bunionette is a bony bump located at the fifth MTP joint, where the little toe meets the fifth metatarsal bone. Like bunions, bunionettes can lead to stiffness, discomfort, and pain, particularly on the outer side of the foot, near the pinkie toe. Swelling and redness around the joint are also common due to inflammation, especially when footwear presses against the area and aggravates the tissues.
Similar to bunions, the pressure and friction from shoes can lead to corns or calluses on or near the little toe. In some cases, bunionettes can also contribute to hammer toes. Bunionettes may also push the little toe inward, causing it to angle toward the other toes and this results in further misalignment and discomfort.
Types and Stages of Bunions
Bunions are classified into types, each with specific characteristics and stages that reflect increasing severity over time.
Standard Bunion (Hallux Valgus)
Hallux valgus, the most common type of bunion, typically progresses through four stages:
- Stage 1 (Mild): A small bump forms as the big toe begins to angle toward the second toe. Symptoms are usually minimal.
- Stage 2 (Moderate): The bump becomes larger, with noticeable discomfort or stiffness, especially in tight footwear.
- Stage 3 (Severe): The big toe overlaps or crowds the second toe, with increased pain, swelling, and limited movement.
- Stage 4 (Advanced): The deformity becomes pronounced, leading to chronic pain, joint stiffness, and difficulty in finding comfortable shoes.
Congenital Bunion
A congenital bunion as its name implies is present from birth due to genetic factors that influence foot structure. While it may initially have mild or no symptoms, the bunion can become more pronounced as the child grows. By adulthood, it often resembles hallux valgus, progressing through similar stages with increasing pain, stiffness, and misalignment.
Bunionette
Just like standard bunions, a bunionette has stages that reflect increasing severity:
- Stage 1 (Mild): A small bump forms as the little toe begins to angle inward toward the other toes. Symptoms are usually minimal.
- Stage 2 (Moderate): The bump becomes more noticeable, leading to pain and inflammation, particularly in snug footwear.
- Stage 3 (Severe): The little toe angles further inward, causing misalignment and increased discomfort.
- Stage 4 (Advanced): The deformity causes persistent pain and difficulty finding suitable footwear, with supportive measures often needed to relieve pain.
Conditions Commonly Mistaken for Bunions
Several foot conditions share symptoms with bunions, such as pain, swelling, or joint misalignment, and may be mistaken for it. Here are some common ones:
- Bursitis: Inflammation of the bursa, a fluid-filled sac that cushions joints, can mimic bunion symptoms such as pain and swelling near the big toe joint. However, bursitis does not cause the same structural changes as bunions.
- Ganglion Cyst: A ganglion cyst is a fluid-filled lump that can develop on the foot, often near joints or tendons. Unlike bunions, ganglion cysts are soft and may change size, causing discomfort primarily due to their location rather than structural misalignment.
- Gout: An inflammatory form of arthritis that frequently affects the big toe joint, causing sudden, intense pain, redness, and swelling. Unlike bunions, gout attacks are often temporary and triggered by dietary or metabolic factors.
- Hallux Rigidus (Osteoarthritis): Hallux rigidus is a form of osteoarthritis affecting the big toe joint, leading to stiffness, pain, and limited motion, especially during movement. While bunions cause the big toe to angle toward other toes, hallux rigidus typically causes restricted motion without the prominent bump.
- Rheumatoid Arthritis: An autoimmune condition that can affect various joints, including the big toe. Rheumatoid arthritis may cause pain, swelling, and joint deformity, sometimes resembling bunions. However, it typically affects multiple joints symmetrically and causes systemic symptoms like fatigue and stiffness.
- Sesamoiditis: This is an inflammation of the small sesamoid bones beneath the big toe joint, causing pain around the area. While bunions cause a visible bump and misalignment, sesamoiditis typically results in pain without visible deformity.
Managing and Preventing Bunions
Although bunions are challenging to prevent, as their exact cause isn’t fully understood, there are options that may help with symptom relief and support foot health:
- Maintain a Balanced Weight: Managing weight may help reduce strain on the feet, potentially benefiting overall foot health.
- Wear Proper Shoes: Choose shoes in wider widths, such as 2E or 4E, as these typically have a roomier toe box. Look for shoes with good arch support and avoid high heels that push your toes together. Stretching devices can also help widen shoes you already own.
- Soak Feet in Warm Water: A warm water soak can help relax foot muscles and ease discomfort around the bunion area.
- Use Pain Relievers with Caution: While nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and swelling, they do have side effects and might be harmful if used long-term. It’s best to use them sparingly and consult a doctor for guidance.
- Consult a Podiatrist: A podiatrist can provide personalised advice and may recommend additional support options such as custom orthotics, cushioned bunion pads, toe separators, splints, or a physical therapy programme to strengthen foot joints and improve alignment.
Find Relief from Bunion Pain at East Coast Podiatry
If you’re experiencing discomfort around your big toe and unsure whether it’s due to a bunion, gout, or another condition, an assessment can provide clarity. At East Coast Podiatry, we start with a thorough evaluation, using advanced imaging to precisely identify the source of your pain. This careful assessment helps us identify the underlying issue and create a plan that provides immediate relief while supporting long-term foot health.
Depending on your needs, we may suggest non-invasive methods like Extracorporeal Shockwave Therapy (ESWT) to alleviate discomfort and target the root cause of bunion pain. Custom orthotics may also be recommended to help redistribute pressure, support alignment, and reduce joint strain. Schedule an appointment with our experienced podiatrists today to create a personalised plan that relieves pain and restores mobility, so you can get back to your daily activities comfortably.
Frequently Asked Questions About Bunions
A bunion is a bony bump that forms on the joint at the base of the big toe when the toe pushes against the one next to it, causing the joint to jut outward. This misalignment often leads to swelling, redness, and pain, especially in tight shoes. A similar condition, called a bunionette or “Tailor’s Bunion”, forms on the outer side of the foot at the base of the little toe, where it creates a smaller bump and can also cause discomfort in snug footwear.
Bunions and bunionettes are typically caused by a combination of genetic and lifestyle factors. Genetics can play a role, as inherited foot shapes such as flat feet, low arches, or abnormal bone structures make some individuals more prone to these conditions. Wearing tight, narrow, or high-heeled shoes also puts pressure on the toes and encourages misalignment over time. Additional contributing factors include foot injuries, conditions like arthritis, and prolonged pressure on the feet from certain activities or occupations.
If you’re noticing pain with a visible bump on the outer side of your big toe joint, especially after wearing poor fitting shoes or spending long periods on your feet, it may be related to a bunion. Bunion pain often comes from irritation and inflammation around the misaligned joint, leading to redness, swelling, and discomfort that worsens with pressure. However, other conditions might cause similar symptoms. Gout, for example, usually causes sudden and intense pain, often with warmth and noticeable redness around the joint. Bursitis also leads to tenderness around the joint, though it lacks the distinct bony bump of a bunion. In the case of sesamoiditis, pain is felt beneath the big toe rather than on the side, while ganglion cysts appear as soft, fluid-filled lumps rather than hard, bony protrusions. Since these conditions can overlap in symptoms, an assessment can help identify the exact cause of your pain and guide you toward the most appropriate care.
No, bunions don’t go away on their own, but there are ways to manage symptoms and make daily activities more comfortable. Starting with cushioned bunion pads, which reduce friction from shoes, you can protect the bunion and ease irritation. Toe separators can also provide relief by gently aligning the big toe, reducing pressure on the joint. If foot mechanics like overpronation are worsening the bunion, custom orthotics can help by redistributing pressure across the foot. For added alignment support, night splints may keep the toe in a natural position while you sleep. In more severe cases, medical options or surgery may be necessary to address alignment and relieve pain.
Hammer toes, mallet toes, and claw toes are linked to bunions and bunionettes because the misalignment caused by these conditions often shifts pressure onto the smaller toes, gradually forcing them into abnormal positions. When a bunion pushes the big toe inward toward the other toes, or a bunionette causes the little toe to angle inward, it can compress the surrounding toes. This compression increases the risk of hammer toes, where the middle joint of the second, third, or fourth toe bends abnormally. Similarly, mallet toes, which cause a downward curl near the toenail, can develop as the smaller toes adjust to the lack of space. Over time, claw toes may also form as all joints in the smaller toes curl downward due to prolonged misalignment. Although bunions and bunionettes often contribute to these deformities, other factors like tight footwear, injuries, or health conditions might also play a role.
