A bunion, medically called hallux valgus, is a change in the alignment of the big toe and the first metatarsal bone. The prominence on the inner side of the foot is only one part of the condition. The big toe may drift towards the second toe, the first metatarsal may move in the opposite direction, and the joint can become rotated, unstable or arthritic.
Two people with bunions that look similar from above may have very different problems. One may have a flexible, mildly painful deformity with a healthy joint. Another may have significant joint degeneration, stiffness, transfer pain beneath the lesser metatarsals or an associated second-toe deformity. These differences influence both non-surgical care and the choice of operation if surgery is eventually considered.
Accurate diagnosis also helps determine whether the bunion is actually the main source of pain. Pain around the big-toe joint may arise from arthritis, gout, sesamoid disorders, nerve irritation, bursitis or an injury. Treating the appearance of a bunion without identifying the true pain generator can lead to disappointment.
A careful assessment therefore combines the history, examination, footwear and activity demands, and weight-bearing imaging when indicated. The aim is not simply to assign an angle or label. It is to understand how the deformity is affecting the individual and whether treatment is likely to improve comfort and function.
For many patients, education, footwear modification and other conservative measures are appropriate. Surgery is generally considered when symptoms remain important despite reasonable non-surgical treatment, rather than because an X-ray or appearance alone seems abnormal.