Can You Have a Bunion on the Second Toe?
No, a true bunion cannot occur on the second toe—bunions specifically affect the first metatarsophalangeal joint (big toe) or the fifth metatarsophalangeal joint (bunionette/tailor's bunion), but the second toe develops different deformities such as hammertoe or claw toe that may cause similar symptoms.
Understanding Bunion Anatomy and Location
A bunion is defined as a bony prominence at a metatarsophalangeal joint with associated angular deformity. The medical literature consistently describes only two types of bunions:
- Hallux valgus (bunion): Occurs at the first metatarsophalangeal joint with medial prominence of the first metatarsal head 1, 2
- Bunionette (tailor's bunion): Occurs at the fifth metatarsophalangeal joint with lateral prominence of the fifth metatarsal head 1, 3, 2
No medical literature describes bunions occurring on the second, third, or fourth toes 1, 3, 2, 4, 5.
What Actually Affects the Second Toe
The second toe develops distinct deformities that may be confused with bunions:
- Hammertoe deformity: Flexion contracture at the proximal interphalangeal joint, which can cause painful corns and calluses 6
- Claw toe deformity: Combined flexion at both interphalangeal joints with extension at the metatarsophalangeal joint 7
- Crossover toe: The second toe may drift over or under the hallux, particularly when hallux valgus is present 7
These deformities cause pressure points, callus formation, and pain similar to bunions but represent fundamentally different pathology 6.
Clinical Significance in High-Risk Patients
While bunions themselves only occur on the first and fifth toes, the American Diabetes Association emphasizes that any foot deformity including bunions, hammertoes, and claw toes substantially increases ulceration risk in diabetic patients through elevated plantar pressures 8. The combination of peripheral neuropathy, minor trauma, and foot deformity is present in over 63% of diabetic patients with ulcerations 8.
Management of Second Toe Deformities
For symptomatic second toe deformities that may be mistaken for bunions:
- Conservative management: Toe spacers, semi-rigid orthotic devices, and custom insoles to redistribute pressure 6
- Professional corn/callus removal: Every 1-3 months for high-risk patients 6
- Surgical intervention: Digital flexor tenotomy is the procedure of choice for non-rigid hammertoes with excess callus or pre-ulcerative lesions 7, 6
The International Working Group on the Diabetic Foot specifically recommends digital flexor tenotomy for neuropathic plantar or apex ulcers on digits 2-5 secondary to flexible toe deformity 7.
Common Pitfall to Avoid
Do not dismiss second toe deformities as "just a bunion"—this misdiagnosis leads to inappropriate treatment. The American Diabetes Association states that foot deformities should not be dismissed as merely cosmetic issues, as they represent critical risk factors for falls in elderly patients and ulceration in those with neuropathy 8. Proper identification of the specific deformity (hammertoe vs. claw toe vs. crossover toe) guides appropriate conservative or surgical management 6.