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A bunion is a bony bump at the base of your big toe.

It happens when the two bones in your big toe joint move out of line with each other.¹ This makes your toe joint stick out. The bony bump is the bunion.²

• Bunions are far more common in women than in men. About half of all women get them.
• Usually, bunions are caused by problems with the shape of your foot and how you walk.
• Wearing shoes that don't fit well makes bunions worse. But these bony bumps also happen in 1 in 50 people who have never worn shoes.
• Bunions usually get worse if you don't treat them. Your toe can hurt a lot, make it hard to walk and limit which shoes you can wear. But these things don't happen to everyone.
• Simple treatments such as shoe insoles may help your bunions hurt less. But an operation is the only way to make your toe straight again.

Your toes, especially your big toe, help you balance. They also help push you forward as you walk or run. You have 14 bones in your toes. They are among the smallest in your body. Two bones meet at the joint of your big toe.

• One is the bone in your big toe. Doctors call this a phalange.
• The other is the main bone in your foot. Doctors call this a metatarsal. It runs along the arch of your foot to your big toe.¹

At the joint, the ends of the two bones are held together by tissue. This is called the joint capsule. It has a lining that makes fluid. The fluid makes your toe joint slippery and helps it move smoothly.

Your toe joints are designed to cope with walking, jumping and other actions you do over and over. Several tissues wrap around each joint. They help keep the joint stable so the bones stay in place. These tissues include ligaments, tendons and muscles. Doctors call them soft tissues.

The joint at the base of your big toe moves more than other joints in your foot. It needs to because it carries most of your weight as you push off your foot when you walk forward. This means that this joint differs a bit from your other toe joints.²

Your big toe joint has two tiny round bones. Doctors call these sesamoid bones. They sit inside a tendon underneath the joint. These tiny bones stop the tendon from getting squashed when you stand on your foot. And they help your toe move up and down in a straight line.

A bunion happens when the two main bones in your big toe joint move out of line with each other.

Usually, this occurs when something upsets the balance of the soft tissues around your joint.

All the parts of a joint depend on each other. When something goes wrong in one part, it affects the others. For example, a bunion may start when the muscles in your foot get tighter and the tendons get looser. This makes your toe joint less stable, so the bones there begin to move.^{1 3 4}

• Your big toe starts to point toward your smaller toes.
• The main bone in your foot starts to point toward your other foot.
• Then the ends of the two bones don't fit together snugly any more at your toe joint.
• As the bones get more out of line, your toe joint starts to stick out.⁵
• This bony bump is the bunion. It's actually the top end of the main bone in your foot.

Often, a sac of fluid forms over the bump. It's like a blister. Doctors call this sac a bursa.^{3 4} The sac can get inflamed when your bunion rubs on your shoes. If this happens, you also have bursitis.

Doctors call bunions hallux valgus. Hallux means big toe. Valgus means bent outward. A bunion is simply a joint that is out of line. It isn't a growth on the side of your toe, as some people think.

A bunion can hurt a lot. You may find it hard to walk. Your big toe may start to roll on its side and cross over your second toe. And your big toe can push your second toe toward your third toe and so on. Your toes may even lie on top of each other in bad cases.^{3 4} Some people get a small bunion, called a bunionette, on their little toe. This is also known as a tailor's bunion.⁶ It can hurt a lot and change the shape of your small toe joint.

Doctors don't really know why some people get bunions. The shape of your foot and how you walk are probably the main causes.⁷ But wearing shoes that are too tight could make the problem worse.

Some things increase your chances of getting bunions. Doctors call these things risk factors. For example, having a long big toe and being a woman make it more likely that you will get bunions.

For more information, see Risk factors for bunions.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.