Ask the doctor: I think I have a bunion — how do I get rid of it?

Dr Grant replies: It is normal to have the dominant side of your body slightly larger than the non-dominant side. Often people notice one foot or hand can be up to a half size larger than the other, or as in your case, slightly wider. I presume you noticed some pain and a slight protrusion at the base of the big toe, or what’s known as the first metatarsophalangeal (MTP) joint.

One of the most common signs of a bunion is inflammation which typically causes pain, possibly some redness and mild swelling over the medial (inner) bursa protecting the first MTP joint. A hallux valgus deformity is the medical term for a bunion and it’s estimated to occur in approx. 30pc of female adults. This bony deformity of the joint at the base of the big toe tends to cause the big toe to move towards the smaller toes. The degree of movement or angulation of the big toe towards the smaller toes helps define the severity of the deformity. This is referred to as the hallux abductus angle and typically an angle of ≥20 degrees is abnormal.

The exact reason why bunions form is poorly understood and is thought to be multifactorial with family history and tight/ill-fitting footwear being two significant contributing factors. Foot anatomy, joint hyper-flexibility and foot biomechanics are also likely to play a role. Other contributing factors include having an underlying diagnosis of rheumatoid arthritis, psoriatic arthritis and/or gout. Interestingly, bunions are rarely seen in parts of the world where people go barefoot.

Certain anatomical factors can increase the pressure under the first MTP joint and force the bone to move in such a way that exacerbates the deformity. Since not all bunions progress to become severe, there may be a threshold up to which the forces causing the deformity can be opposed by other anatomic structures. When forces greater than the threshold occur, the joint becomes deformed. It is possible that such progression occurs rapidly rather than worsening steadily over several years.

Sometimes people can identify a particular activity or exercise that brings on pain in the first MTP joint, for example after running. Is there any chance you might have taken up an exercise recently that might be contributing to your deformity? Runners can experience pain/swelling in this joint when running long distances or perhaps after switching to a new brand/style of runner.

For anyone over 50 years old, early degenerative changes (osteoarthritis) could be a potential cause for the bony bump. Osteoarthritis (OA) of the first MTP joint (big toe) is common. Early OA changes can be seen on MRI scan and more established OA will be noted on foot X-ray. A foot X-ray allows the bony structure of the foot to be clearly seen, as well as the degree of movement and deformity caused by the bunion. On balance, though, the majority of people with a mild bunion and non-severe symptoms do not warrant X-ray or other imaging.

There are plenty of conservative options for managing bunions, including wearing wide-fitting footwear, placing orthotics in your footwear, wearing splints at night, wearing toe separator (soft wedges can be placed between the first and second toe) during the daytime, or undergoing manipulation and stretching exercises under the guidance of a trained professional with repetition of these exercises at home. It must be noted that in a clinical trial setting, none of these conservative options have been shown to give any statistically significant efficacy. Surgical correction is generally only considered for severe deformity, or for those in severe pain or discomfort.

In your case, I think it would be a good idea to attend a physiotherapist for an assessment of your foot anatomy, arch, biomechanics and overall gait.

Dr Jennifer Grant is a GP with Beacon HealthCheck