Bunions and toe deformities

What are bunions and toe deformities?

Bunions are bony prominences that can develop at the base of the big toe.

Toe deformities occur when changes to the toe joints cause clawing, retracted or hammer toes that appear misshapen.

What causes bunions and toe deformities?

Bunions - bunions occur as a result of a change in position of the joints in the foot. It is thought that flat feet or low arches can reduce the stability in the joints of the foot causing the bone behind the big toe (the metatarsal) to drift away from the centre of the foot. The big toe however, is prevented from moving in the same direction as the metatarsal by ligaments and muscles that pull it back. As the two bones move in different directions, their joint protrudes thus creating a bunion. The big toe is then angled excessively towards the second toe.

Toe deformities - Hammer toes are more likely to affect the second toe (next to the big toe) and clawed or retracted toes tend to affect the third to fifth toes. The toes bend upwards and do not straighten out when walking. It is not uncommon for only one toe to be affected. It can be a condition that you are born with or develop later in life.

Toe deformities may be caused by a muscle imbalance in the feet or as result of a flat feet or fallen arches which can reduce the stability of the joints in the feet and in turn lead to muscle imbalance.

Hammer or clawed toes can be made worse by tight fitting footwear or socks, particularly during childhood when growth and development may be restricted.

What are the signs & symptoms of bunions and toe deformities?

Bunions and toe deformities are extremely common though not all are painful and require treatment. However you may experience one or more the following signs and symptoms -

Bunions -
  • Bony prominence at the base of the big toe
  • A bursa (fluid filled sac) develops where the bunion has rubbed against tight footwear. This may be accompanied by redness and swelling
  • Pain in the bunion joint. This is due to the arthritic process that is occurring at the joint as a result of the change in position of the bones
  • Callus or a corn developing over the bunion joint or underneath the big toe joint (see callus and corns)
  • Bunions can develop on one or both feet
  • Family history of bunions (ie. parents, grandparents)
  • The big toe may press against or overlap the second toe. This can cause the second toe to become a hammer toe.
Toe deformities -
  • Bent and misshapen toes that do not straighten out during walking
  • Prominent joints which may become inflamed and sore from rubbing on tight shoes
  • Callus and corns develop on the prominent joints, at the end of the toes and under the nails (see callus and corns)
  • Thickened nails caused by the end of the toe pushing against the ground
  • Pain and cramp in the toes made worse by tight fitting shoes
  • Visible 'bumps' in the toe area of the shoes where the bony prominences have stretched the shoe material

Treatment of bunions and toe deformities

As bunions and toe deformities involve changes to the joint, there is no way of curing or reversing them. Treatment is designed to limit the progression of joint changes and prevent or relieve symptoms that may develop.
  • Wear wide, comfortable footwear made of a soft material ie. leather to accommodate the increased width or depth of the foot. Ensure footwear supports the arches of your feet to stabilise the joints (see Footwear guide)
  • Insoles for your shoes may prevent or slow down more joint changes and improve foot function (see Biomechanics and orthotics)
  • Protect prominent joints from rubbing against footwear by covering with felt or gel padding. Pads to 'prop up' and straighten toes can be helpful for those with clawed toes
  • A podiatrist can remove corns and callus and reduce thickened nails safely
  • Surgery may be necessary to correct the position of the joints and straighten the toes, though is not advisable for cosmetic reasons only. (See Foot surgery)

What can a Podiatrist do?

  • Treat callus and corns
  • Cut and reduce thickened nails
  • Provide padding to protect painful areas from pressure and friction from footwear
  • Advise on footwear
  • Assess your foot alignment and prescribe orthotics and stretching exercises
  • Refer you to a podiatric or orthopaedic surgeon

When should I seek medical care?

If you notice any redness, increased swelling, bleeding or infection, see a podiatrist or your GP.