What are the treatment options for a bunion?

Treatment Options for Bunions

Initial management of symptomatic bunions should be non-operative, with accommodative footwear as the cornerstone, supplemented by NSAIDs, orthotics, splints/braces, and toe spacers; surgery is reserved only for patients with persistent painful prominence who have failed conservative treatment and are suitable operative candidates—cosmesis alone is never an indication for surgery. 1

Conservative Management (First-Line Treatment)

Footwear Modifications

• Accommodative footwear is the most important initial intervention to reduce friction and pressure on the bunion deformity 1
• Wide toe-box shoes reduce mechanical stress on the medial eminence and allow proper toe alignment 1

Pharmacological Options

• NSAIDs provide symptomatic pain relief and reduce inflammation associated with bunion-related soft tissue irritation 1
• Use the lowest effective dose for the shortest duration to minimize gastrointestinal and cardiovascular risks 1

Orthotic Devices and Mechanical Interventions

• Orthotics are evidence-supported for redistributing plantar pressures and may address biomechanical factors contributing to bunion progression 1
• Splints, braces, and toe spacers have demonstrated efficacy in providing symptomatic relief, though they typically do not correct the underlying deformity 1
• These devices work by reducing friction, improving alignment during rest, and potentially slowing deformity progression 1

Exercise-Based Therapy

• Foot muscle strengthening exercises may reduce bunion-related pain and improve mobility, as weak intrinsic foot muscles may contribute to both pain and functional limitations 2
• Strengthening programs target the intrinsic foot musculature to improve biomechanical stability 2

When Conservative Treatment Fails

Indications for Surgical Referral

• Refer to an orthopaedic surgeon when the patient has a painful prominence, has exhausted non-operative treatment options, and is a suitable operative candidate 1
• The presence of pain with functional limitation—not cosmetic concerns—drives the surgical decision 1

Important Contraindications and Timing Considerations

• Smoking is a relative contraindication to bunion surgery, and cessation should be strongly recommended before proceeding with operative management 1
• In paediatric or adolescent patients (juvenile bunion), surgery must be delayed until skeletal maturity to avoid recurrence and growth-related complications 1

Critical Pitfalls to Avoid

• Never recommend surgery for cosmetic reasons alone—this is not an appropriate indication and exposes patients to unnecessary surgical risks 1
• Do not proceed to surgery without first attempting comprehensive conservative management, as many patients achieve adequate symptom control with non-operative measures 1, 3
• Recognize that conservative treatments may not provide long-term relief in all patients, and timely surgical referral is appropriate when conservative measures fail rather than prolonging ineffective treatment 1
• Be aware that up to 15% of bunions recur after surgery, which underscores the importance of patient selection and realistic expectation-setting 2

Special Considerations for Bunionette Deformity

• Bunionette (tailor's bunion) deformities are usually responsive to nonsurgical management similar to hallux valgus bunions 3
• Conservative management includes shoe wear modification and orthotics, particularly when excessive subtalar joint pronation contributes to symptoms 4
• Surgical options are available based on the underlying bony deformity when nonsurgical treatment fails, with procedures ranging from resections to various osteotomies 3, 4