Bunion symptoms are not always located at the medial bump. As the big toe drifts towards the second toe and the first ray functions differently, pressure may shift to other areas of the forefoot. Patients may develop a corn between the toes, a callus beneath the second metatarsal head, second-toe elevation or pain beneath the ball of the foot.
Debridement of a painful corn or callus may provide relief, but the lesion can recur if pressure remains. Footwear width and depth, toe-box shape, padding, insoles and orthoses may be used to reduce local loading. A toe prop or separator may help selected patients, provided it does not increase crowding inside the shoe.
The second metatarsophalangeal joint should be assessed when there is pain, swelling or the sensation of walking on a pebble. Plantar plate injury, instability or a stress-related condition may coexist with a bunion and may require a more specific plan. Treating every forefoot symptom as “just the bunion” risks missing an important associated diagnosis.
People with diabetes, neuropathy or poor circulation should not self-treat corns using medicated pads or blades. Professional assessment is important because apparently minor skin pressure can progress to ulceration in a high-risk foot.
When lesser-toe deformity or transfer pain has become established, correction of the bunion alone may not address every problem. This is one reason a complete forefoot examination is important before any operation is selected.