Bunions or “a stone in my shoe”

Bunions are widespread in the population and definitely one of the most prevalent conditions in our foot and ankle clinic. Some people may be significantly aggravated, as it can cause severe daily limitations.  Bunions can become a problem some people may have to face every morning at the time of fitting into shoes, and as such the right treatment should be implemented.

What are bunions?

Bunions are a bony protuberance formed at the base of the big toe commonly used to describe a misalignment of some bones in the foot. The tip of the big toe will shift towards the lesser toes causing the joint at the base of the big toe to stick out. The medical term which describes a big toe bunion is “hallux valgus”.

A less common form of bunion also known as “bunionette” can develop in the articulation of the pinky toe.

Why do they occur?

Although the use of “less sensible” shoes frequently takes the blame for the occurrence of bunions, it’s not all due to footwear. Some types of footwear, and high heels in particular, have taken the blame for bunions but it is not totally clear whether footwear is a causing factor for bunions

The available studies that try to answer this question are non-conclusive mainly because it is very difficult to isolate the effect of footwear from other causative factors such as genetic background or ligamentous laxity.

One recent study concluded that high heels do not cause foot deformation but contribute to more foot pain and callosities.

Others have shown some evidence in favour of the fact that high heels can be a cause for bunions. So the jury is still out.

Other proposed causes for bunions include genetic background that dictates foot shape, congenital deformities, specific trauma or arthritis.

What are the common symptoms?

The protuberance over the inside of the big toe is the defining feature of bunions. Normally this area becomes swollen, red and tender. There can also be areas of hard skin or calluses around the big toe and underneath the ball of the foot. Pain may be present constantly or it may come and go. On occasions, stiffness in the big toe joint can also develop over time.


To help prevent bunions, choose your shoes carefully. They should avoid crowding of the toes with a wide and comfortable shoe box and no pressure points.

Multiple devices, toe correctors and spacers have been described and are sold as a cure for bunions. However, the latest research shows that none of the available orthotics will correct the deformity; some may be helpful to deal with pain.

The goal of surgery

Even though a neat result is always pursued during surgery, a purely cosmetic desire is never an indication to undergo surgery. The main goal of surgery is to straighten the toe and provide functional improvement to allow comfortable footwear.

When shall I seek medical attention?

Not all bunions will require medical treatment, although it is recommended to seek attention if any of the following occur:

  • Frequent or constant pain in the big or lesser toes
  • Reduced or painful motion of the big toe
  • Difficulty in finding appropriate shoes due to the bunion
  • Limitations in routine or sport activities

Recognising the signs and symptoms of these conditions is crucial for seeking timely medical attention. Mr Francesc Malagelada is dedicated to diagnosing and treating various foot and ankle conditions, providing personalised treatment plans to address your specific needs and help you get back on your feet comfortably. Contact us and book an appointment today!

Keep in mind that our blog is also a great place if you’d like to stay updated on the latest orthopaedic news.

This article is for information purposes only and is not a substitute for professional medical advice. Consult your physician for personalised guidance. In case of a medical emergency, contact your doctor or emergency services.