Bunion or Hallux valgus
Bunion
There are several common deformities of the big toe which are (incorrectly) often all bundled together as a bunion. A true hallux (big toe) valgus (deviation away from the centre of the body) is a deformity occurring at the MTP joint. There is a widening between the 1st and 2nd metatarsals which leads to an "off-centre" pull of the big toe tendons, pulling the big toe into a deformed position and producing the bunion 1st metatarsal prominence.
Bunion
It is commonly confused with hallux interphalangeus (where the deformity lies more distally and which tends to be less problematic). Here there is no increase in the space between the metatarsals, and the deformity lies in the shape of the phalynx bone.
Hallux interphalangeus
Hallux rigidus (arthritis of the big toe) is when the lump sits on the top, not the side of the toe. To add more confusion all these conditions can sometimes all co-exist in the same toe. 
Hallux Rigidus
How does a bunion occur? (explain my bunion to me?)
A true hallux valgus or bunion results from a drifting inwards of the big toe metatarsal from its normal position closer to the second metatarsal. The bunion is the head of this first metatarsal which produces the prominence on the inner side of the now wider foot. Tendons run circumferentially around the metatarsal and toe. They both move and stabilise the toe under normal circumstances. In a bunion, with the shift/displacement of the first metatarsal these tendons no longer lie in the correct axis and in fact act as a deforming force, contributing to the bunion.
Where, why and when might I expect to get bunion pain? 
Where and why has bunion pain occurred?
The most common spot for bunion pain is the inner border of the big toe at the point of maximum width due to local pressure. Bunion pain can also come from the second toe, either from the top as it is pushed upwards by the big toe or from its under surface. This is due to the second toe 'working harder' as the big toe deforms and becomes less useful in the final 'push off' in walking. Occasionally a patient may suffer with an unpleasant numb feeling along the inner border of the big toe. This is due to pressure or irritation of a nerve that sits close to the bunion.
When is bunion pain most acute?
Bunion pain is most often present when walking in enclosed shoes. There may be little bunion pain in sandals or barefoot. It is unusual to have much bunion pain when not putting weight on the foot or at night. If there is bunion pain at rest or at night then there may also be arthritic change within the toe. Why do bunions occur?
The causes of bunions are "multifactorial". In other words generally many things contribute to their occurence. Shoewear per se is a contributory factor but it isn't possible to say that the type of shoewear is necessairily relevant. Often there is a hereditary component with other family members also suffering with the same condition.
What treatments are available for my bunion?
The choice of bunion treatment lies between non-operative and operative. The options with non-operative management of bunions are wider shoes, softer leather shoes, sandals in summer, custom wider box shoes and silicon spacers between the first and second toes. If a patient has a flat foot as well (a recognised association) an arch support may also be of help. These will not treat the underlying problem but may make bunion symptoms more tolerable. If I have a bunion is the best treatment surgery?
The decision on bunion operative treatment is usually made on the basis of the level of pain and inconvenience caused by the bunion or second toe. There is no correct answer to the question, bunion pain and inconvenience are both highly subjective. An inability to get into a formal shoe may be a major problem for a business woman or man but no problem at all for someone wearing trainers every day. However in general if a bunion is free of pain then the recommendation would not be for surgery. That said, this is not an absolute. Once a patient has read this section and appreciated what surgery and the recovery entails the patient will be in a better position to discuss the possibility of bunion surgery for their symptoms. | 
