Not every bunion is painful. Some people notice the change in shape but continue to walk, exercise and wear shoes comfortably. Others develop symptoms that gradually interfere with work, recreation or everyday footwear.
The most common symptom is pain or tenderness over the prominence on the inner side of the big-toe joint. This is often caused by pressure and rubbing from footwear. The skin may become red, irritated or thickened, and the small bursa over the joint may become inflamed.
Pain may also arise from within the joint itself. As alignment changes, joint loading can become uneven. Some patients develop stiffness, reduced movement or arthritis of the first metatarsophalangeal joint. Pain under the ball of the foot may occur when weight is transferred away from the first ray towards the lesser metatarsals.
The big toe can crowd the second toe, contributing to a hammer toe, overlapping toe, corns or irritation between the toes. In more advanced deformities, fitting ordinary shoes may become increasingly difficult even when pain is not severe.
Symptoms are not always proportional to the visible size of the bunion. A relatively small prominence can be very painful in firm footwear, while a larger deformity may remain surprisingly comfortable. For this reason, treatment decisions should not be based on appearance or X-ray angles alone.
It is also important to confirm that the bunion is truly the source of pain. Arthritis, sesamoid disorders, nerve irritation, gout, stress injury and other forefoot conditions can produce symptoms around the big-toe joint. A careful examination and, where appropriate, weight-bearing imaging help distinguish these possibilities.
Assessment is particularly worthwhile when pain persists, footwear choices are becoming restricted, the deformity appears to be progressing or the lesser toes are beginning to change position.