Bunion Deformity - DOC

Bunion Deformity

How a bunion develops by San Francisco Foot Surgeon

A bunion is a nothing more than a bump or enlargement of the bone and joint at the base of the big toe. This joint is called the first metatarsophalangeal joint (MPJ). A bunion forms when the joint becomes misaligned and the bone or soft tissues at the big toe joint start to move out of place. What happens is that the big toe starts to bend over toward the other toes. This causes the bone to stick out.

How a bunion develops by San Francisco Foot Surgeon 

A bunion is a sometimes painful structural deformity of the bones and the joint between the foot and big toe. Bunions develop via long-term warping caused by pointed shoes during the growth phase of the foot,causing this joint at the base of the big toe to thicken and enlarge. This causes the bones of the big toe to angle in toward the second toe, and leads to an often painful lump of bone which forms at the outside-edge base of the big toe. The pressure of the point in the shoe, simultaneously causes ingrowing toenails. Hammer toes are caused by cramped shoes too. It should also be noted that bunions and hammer toes often occur in the same patients simply because the have a genetic tendency to develop these foot problems.

Bunion begins as big toe and metatarsal drift in opposite directions.Joint capsule gets thicker as the bunion gets bigger. Bursitis flares and bunion becomes red and painful. 

Over time, the soft tissues that are covering that bone then becomes irritated red and inflamed. This causes a painful knot of bone. Because this joint carries the majority of the body’s  weight while walking, bunions can become extremely painful. Eventually the big toe joint itself may become arthritic, stiff and sore. This can make walking and fitting into shoes extremely difficult. 

Diagnosis of a bunion

When you suspect you have a bunion, your doctor should begin by taking a history of your condition to make sure that he has the full story. A physical exam will also be performed to determine the condition of the big toe joint, note any associated deformities, and evaluate the biomechanics of your foot. Xrays are usually performed as well to help evaluate the extent of malalignment of the bone and to look for arthritis. 

These tests are usually sufficient for your foot surgeon to get an idea of the treatment that will be required. The results of all of these tests are usually explained on the first visit so that you can get a full understand of how bunions begin, what you can do to fix your bunions, and which bunion treatment that will be most appropriate in your case. 

How does a bunion form?

Bunions form in two basic ways. Either the metatarsal bone drifts out of position or the big toe is pushed out of position.  In most cases, bunions are really the result of genetics.  Loose ligaments, flat feet, and instability of the metatarsal bone that connects to the big toe can set up the formation of a bunion.

As you walk, there is a tremendous amount of force being applied to your big toe joint.  In fact, 50% of all of your weight is supported by the big toe joint with each step.  The other 50% is divided up by the other joints in the ball of the foot.

If the foot pronates and rolls inward, even more force is applied to this joint. As a result, the first metatarsal bone can gradually drift out.  The bone in the base of the big toe (called the proximal phalanx) is held firmly in place by several muscles and tendons. So as the metatarsal bone moves in one direction, the big toe moves in the other, and begins to bump up against the second toe.

This is the point that people start to notice a bunion.  The hard bump that can be felt under the skin on the foot at the big toe joint is actually the head of the first metatarsal bone.  As time goes on, irritation from shoes can cause the skin to become red and irritated. Bursitis can also developed if the joint becomes inflamed. With continued rubbing in shoes, the bone reacts and a bony knot called “osteophytosis” develops making the bunion even larger. 

Do shoes cause bunions?

Although shoes don’t cause bunions, they can make them form faster and hurt worse.  Whenever a bunion develops, the bump that sticks out can become irritated and painful. 

Tight shoes (particularly those with a prominent seam) that rub against the bunion can cause tremendous pain. When the shoes rubs on this area, the skin becomes red and raw. The underlying bursa (a little fluid-filled sack over the joint) becomes swollen and tender (this is called bursitis).  The metatarsal bone can even start to grow and develop bone spurs in response to all the friction. Each of these three problems can make the bunion seem bigger and more painful.

If you have a bunion, it is essential that you wear shoes that are supportive. By supporting the foot and arch, you can decrease the amount of stress on the big toe joint. Otherwise, it get worse and more deformed over time. Avoid high-heeled shoes whenever possible, as the steep angle of the heels will place an enormous deforming force on the bunion.

Most of all, stop wearing shoes that have seams or stitching that you know will aggravate the bunion.  As you probably already know, once the bunion becomes red and inflamed (with bursitis) it is very difficult to fit into even your most comfortable shoes without pain.

Will my bunion go away?

Once a bunion forms, it cannot go away on its own. The deformity is permanent unless corrected with surgery. 

There are many splints, spacers, pads and other devices on the market which claim to “straighten” bunions. Unfortunately, these devices cannot realign the bone or correct the muscle and tendon imbalances that often accompany a bunion deformity.  While you can expect to decrease irritation of the bunion with padding, you can’t expect the bunion to straighten out. 

Why do bunions get worse?

Bunions are a progressive deformity. This means that they will typically get worse over time. It is true that the foot becomes more unstable as the bunion gets bigger.  This means that it will often get worse at faster rate over the years. Having said that, it is unpredictable as to just how fast the bunion will become intolerable.

As a general rule, bunions are a surgical problem. However, you should only have your bunion surgically removed if it is painful or interfering with the activities you enjoy. Once you start to picture what your life would be like if you had no bunion pain, that it is when it makes sense to talk with your foot surgeon about fixing the problem.

Why do bunions hurt in winter?

Many patients have told me that they believe that cold weather makes bunion hurt worse. Well, this is sort of true.

The first thing that you need to know is that for most women with bunions, fall and winter attire means a radical shift in the types of shoes you will wear. Suddenly, you switch from open sandals with skinny straps and very little pressure to closed toed shoes and boots.

With closed-toe shoes and pointy boots, there is simply more of a chance that the bunion will get rubbed the wrong way.  Once the irritation begins, the underlying bursa becomes red, hot and very painful.  It is then often painful to wear almost any shoes at all.

Once you have bought those stylish new boots, you also have to break them in. Creases in the leather that develop as they are being broken in may push right on the big toe joint. To make matters worse, they can have seams or stitching that also rub on the bunion making it sore.

If the boots also happen to have a significant heel, there is even more pressure on the big toe joint and bunion.  This can cause pain now, and a bigger and worse bunion later.

None of this means you can’t wear fashionable fall and winter shoes. It just means that you’ll need to get used to them gently and slowly.

The best way to ease into the wintry shoe season is by choosing three or even four different styles. Just make sure that each of them has a different heel height. They should also have stitching or seams in different locations. This will decrease the chance of any irritation.

If you’ve ever felt guilty about shopping for shoes, this is your lucky day. Consider this article a doctor’s prescription to buy some new shoes! Yes, you may even tell your husband it will be healthy. 

Bunion Treatment

How are bunions treated?

Some bunions can be  managed without surgery, and foot specialists emphasize that prevention is always best. To minimize the chance of developing a bunion, choose shoes that have square/flared toe ends. Shoes, which are short, tight, or sharply pointed must be avoided. No other primate suffers from bunions as homo sapiens is the only species that wears shoes.

Also, avoid high-heeled shoes if you already have bunions, as they push the foot tight into the toe area. If you are developing a bunion, wear shoes that are roomy enough not to put pressure on it, which should help with a large amount of the pain associated with a bunion. If bunions are left untreated, they can lead to the risk of serious infection in some patients (such as people with diabetes).

Surgery is the main treatment for bunions since it is a fixed bony deformity. A patient can expect a 6- to 8-week recovery period, but most can walk without crutches while recovering. Other measures include various footwear like gelled toe spacers, bunion pads, toes separators, bunion regulators, bunion splints, and bunion cushions. 

Does bunion surgery hurt?

When anyone has suffered from painful bunions and starts to think about bunion surgery, they always ask me…is bunion surgery painful? Bunions surgery does not have to be painful. With the obvious disclaimer that any surgery certainly can be painful, it does not have to be.  There are many techniques the properly trained and skilled foot surgeon can use to ensure that you have as little discomfort as possible related to your bunion correction surgery. 

First, make sure your bunion will provide local anesthesia before your surgery starts. This is important because making the foot completely numb before the procedure starts will help to ensure that you do not experience the “anesthesia awareness” that has recently been reported on it the news.  This is the situation where someone might be unconscious for the surgery, but still actually feel pain.  If your foot is numb because it has been made numb with local anesthetics before the procedure begins, this can prevent that otherwise rare occurrence. 

In addition, make sure that your surgeon utilizes (so you will benefit from) all of the latest developments in post-operative pain reduction. For example, Dr. Segler worked on research related to a low-cost method of reducing pain following bunion surgery. In that study, nearly all of the patients reported taking less pain medicine and believed that there pain much less than had the “pain pump” not been placed in the surgical site and used in their foot surgery cases. He published the secrets on this technique in a medical journal called Ambulatory Surgery in order to teach other foot surgeons how to make bunion surgery better for their patients. If you are one of the many foot surgeons across the country interested in this technique, you can reach the published article by contacting Dr. Segler. If you are a foot surgeon interested in the surgical instrument Dr. Segler invented to simplify complicated bunion procedures, contact Dr. Segler. 

You should also make sure that you have access to other postoperative pain reducing techniques such as cryotherapy. This is a very simple device that circulates temperature controlled cooling through a special pad incorporated into the dressings applied at the time of surgery. By continually icing and cooling the surgical site for first couple of days after surgery, patients have less pain, less swelling, and recover faster.

Post-operative pain is not an unpleasant annoyance, but it is also generally healthy. Pain can actually impede wound healing and stall your recovery. For these reasons, your foot surgeon should use every single effective method to make sure that bunion surgery goes smoothly and with as little discomfort as possible. Your feet are critically important to your ability to enjoy everything from walks on the beach to dancing important, and you should only expect the very best performance from your surgeon when considering corrective foot surgery.

It is important to not only imagine what your life would be like without the pain from bunions, but also to think about how simple bunion surgery could be if you chose a surgeon who would help ensure the fastest most comfortable surgery possible.

How to find a qualified bunion surgeon

Thinking about surgery, whether bunion surgery or brain surgery, can a potentially stressful and serious decision. It is obviously important that you, as a patient considering surgery, make the right decision. If you know which questions to ask, you should have no trouble finding a well qualified foot surgeon who can remove the bunion, relieve your pain, and get you back to all the activities that help you enjoy life on your feet.  

Keep in mind that there are many well qualified doctors in almost every area of the country who are capable of successfully performing your bunion surgery.  The goal is to help you discern the valid qualifications from the dubious ones.  In this way, you should be able to determine for yourself, whether or not the surgeon you have chosen is likely to provide you the outcome you want…no bunions and a return to the activities that make life enjoyable.

Board Qualification

This is the area where most of the confusion lies. In the United States, the foot and ankle surgeons with the most hours of foot surgery training, who are held to the highest standards and who also have the most rigorous board qualification testing are affiliated with the American Board of Podiatric Surgery. So the confusing part is that there are many other “board certifications” such as the “American Board of Multiple Specialties in Podiatry” and the “American Board of Foot Surgery.”  While these “alternate boards” might sound official, they are very rarely accepted as any sort of proof of surgical skill or competency by the hospital committees that grant surgical privileges.


Your surgeon should have three years of surgical training in a foot and ankle surgical residency after graduating from medical school. The more training, the more experience with a wide range of surgical methods and techniques. They say doctors are “in practice,” and the more practice your surgeon has the better.


Make certain your surgeon has experience with medical research, (particular in the areas of your particular problem). This will help to ensure an interest in finding ways to perform surgery better.  A long history in practice by itself is not enough to indicate that your foot surgeon has the advanced skills you are looking for. Medical research separates leaders from followers.  The leaders of course stay out in front, searching for the latest innovations in surgical technique. 


Less than 1% of all surgeons (in any specialty) will have won awards for advancing their particular field.  If you find an award winning surgeon, you have likely found the best of the best. Check your surgeon’s website or search the internet for evidence of awards indicating they are at the top of their specialty. 


Surgery is both a science and an art form. A very useful trait in a surgeon is to creatively identify new solutions to surgical challenges. Look for a surgeon who has demonstrated innovative thinking such as patenting a surgical instrument or technique that can improve the outcome of the surgery.  


As we all know, the word “authority” starts with “author.”  Those who write books, publish articles in medical journals and work to share knowledge and educate other surgeons are always staying on top of their game.  A little searching of the surgeon’s name on Google, will reveal a great deal.  If they are a winner, you will have many hits. 

Although selecting the right surgeon can be stressful, keep in mind that you are simply taking the first step to getting better. With the right surgeon, your foot surgery should be a great experience because it signifies the beginning of your recovery, as well as the beginning of a renewed more active and enjoyable life. The time you invest to research your surgeon’s qualifications will be time well spent. 


What if I already had bunion surgery by another doctor, but I got a bunion again, will Dr. Segler help me?

Due to the demand for his surgical expertise, Dr. Segler is only able to accept revisional bunion surgery cases on a limited basis. If you have already had bunion surgery by another doctor and would like to be seen for an evaluation, you must complete our Foot and Ankle Surgical Second Opinion Evaluation Application. Dr. Segler will review the information you provide and will make a determination about whether or not he can help you and will accept your case.  Once this has been completed and returned, our staff will contact you and inform you of the outcome of your application. You will typically receive a response within 1 business day.