Bunions can be hereditary but they are more often acquired as a result of prolonged pressure on the foot caused by narrow-toed, high-heeled shoes. Such shoes compress the big toe and push it toward the second toe. The condition may become painful as extra bone and a fluid-filled bursa grow where the base of the great toe meets the foot and the overlying skin.

These changes lead to inflammation, swelling and pain. This condition occurs more frequently in women.

• Reddened skin over the base of the great toe
• Pain over the joint where the great toe joins the foot (MTP joint), aggravated by pressure from shoes
• Great toe turns toward the other toes

During a physical exam, the doctor will look for a great toe angled towards the second toe and red, calloused skin on the inside of the foot where the base of the first toe joins the rest of the foot. There is often a bony prominence in this same area.

A foot X-ray will demonstrate an abnormal angle between the first toe and the foot and in some cases arthritis.

In the early stages, good foot care and wide-toed shoes may prevent the need for further treatment of the bunion. Felt or foam pads on the foot to protect the bunion, or devices to separate the first and second toes at night, may reposition the joint.

If the bunion progresses -- resulting in severe deformity or pain -- surgery to realign the toe and remove the bony prominence (bunionectomy) can be effective. There are over 100 different surgical techniques that have been described to treat this condition.

The outlook depends on age, the person's activities, and severity. Adolescents do less well than adults. Many adults do well by caring for the callous and wearing different shoes. Surgery reduces the pain in about 86% of patients.

• Chronic foot pain
• Foot deformity
• Stiff foot
• Hallux varus (occurs with surgical over-correction and the toe points away from the second toe)

Call for an appointment with the health care provider if bunions continue to cause pain after good foot care and wearing wide-toed shoes.

Avoid compressing the toes of the foot with narrow, poor-fitting shoes.