The consultation begins with a detailed history. Important questions include when the bunion became noticeable, whether it is changing, where the pain occurs, which shoes or activities aggravate it, and what treatments have already been tried. Previous injuries, arthritis, inflammatory conditions, diabetes, smoking, medication and prior foot surgery may also affect treatment planning.
The foot is then examined while both seated and weight bearing. The clinician assesses the position of the big toe, the prominence over the first metatarsal head, skin irritation, callus formation and whether the big toe is pressing against or beneath the second toe. The lesser toes are also checked because hammertoes, plantar plate problems and transfer calluses can occur alongside a bunion.
Joint movement is important. A painless, mobile first metatarsophalangeal joint suggests a different problem from a stiff or arthritic joint. The examiner may assess whether the deformity is flexible or fixed, whether the first ray is unstable, and whether the big toe can be realigned without causing joint incongruity or pain.
Circulation and sensation should be documented, particularly before any procedure is discussed. Tendon function, calf tightness, foot posture and walking pattern may also be relevant. These findings help identify factors that might contribute to symptoms or influence recovery.
Weight-bearing X-rays are commonly requested when symptoms are significant, when surgery is being considered or when the diagnosis is uncertain. They show the alignment of the bones while the foot is loaded and allow the joint, sesamoids and associated deformities to be assessed.
At the end of the consultation, the findings should be explained in understandable terms. The patient and clinician can then discuss whether monitoring, conservative care or a surgical opinion is the most appropriate next step.