- A bunion (hallux valgus) is a structural deformity where the big toe drifts toward the second toe and the base of the joint pushes outward.
- Bunions are largely genetic, though footwear can accelerate their progression.
- Conservative care — wide shoes, splints, padding, orthotics — relieves pain but does not reverse the deformity.
- Surgery is the only definitive correction and is offered when pain or progression interferes with daily life. Modern techniques have much faster recovery than older procedures.
- Our surgical podiatrists, Dr. Horvath and Dr. Melillo, perform bunion correction at our Tigard Locust office.
What are bunions?
A bunion — clinically called hallux valgus — is a structural deformity of the big toe joint. The big toe gradually angles inward toward the second toe, and the base of the toe (the first metatarsal head) pushes outward, creating the characteristic bump on the inside of the foot. Over time the joint becomes inflamed, the surrounding tissues stretch, and the deformity worsens.
Bunions are largely inherited — if your mother or grandmother had bunions, you have a higher chance of developing them. Footwear does not cause bunions in the strictly genetic sense, but tight, narrow, or high-heeled shoes do accelerate the progression and worsen the pain. They are more common in women and tend to develop in midlife, although they can show up earlier.
At Northwest Extremity Specialists we follow a conservative-first philosophy with bunions: padding, wider footwear, custom orthotics, splints, and anti-inflammatories can keep many patients comfortable for years. When pain begins to limit daily activity or the deformity progresses, our surgical podiatrists — Dr. Mia Horvath and Dr. Thomas Melillo — offer modern bunion correction at our Tigard Locust office. Today's minimally invasive techniques mean faster recovery and better long-term outcomes than the bunion surgery many patients remember from a generation ago.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
The big toe joint (first metatarsophalangeal joint, or 1st MTPJ) is where the long bone of your foot meets the first bone of your big toe. It is one of the highest-load joints in the body — every step you take pushes off through this joint. In a bunion, the metatarsal angles outward and the toe angles inward, the protective cartilage in the joint wears unevenly, and a fluid-filled bursa often develops over the prominent bone, contributing to the painful bump.
What it feels like
Bunions typically progress gradually. Common symptoms include:
- A visible bony bump on the inside of the foot at the base of the big toe
- Pain or burning at the bump, especially in tight shoes
- Redness, swelling, or warmth over the bunion
- Stiffness or limited motion in the big toe joint
- Calluses or corns where the big toe rubs the second toe
- Pain that worsens with standing, walking, or wearing certain shoes
- In advanced cases, the second toe lifts or crosses over the big toe
Why it develops
Bunions develop through a combination of inherited structure and environmental factors:
- Family history of bunions — by far the most important factor
- A foot type with looser ligaments around the big toe joint
- Years of tight, narrow, or pointed-toe footwear
- High heels that push the foot forward into a narrow toe box
- Flat feet or overpronation, which increases load on the big toe joint
- Certain inflammatory conditions like rheumatoid arthritis
How we diagnose bunions
A bunion is typically obvious on physical exam — but the full evaluation matters. Your podiatrist will assess the size of the deformity, the range of motion of the joint, the position of the second toe, and your foot type overall. Weight-bearing X-rays taken in our office measure the underlying bone angles, which directly inform whether (and which) surgical procedure would be appropriate. Most patients leave the same day with a clear picture of what's going on and what their options are — including a candid conversation about whether surgery is needed now, later, or potentially not at all.
Non-surgical care
Conservative care will not reverse a bunion, but it can relieve pain and slow progression — and many patients do well with non-surgical treatment indefinitely:
- Wider, lower-heeled shoes with a deep toe box
- Padding or bunion sleeves to cushion the prominent bone
- Custom orthotics to address underlying foot mechanics
- Toe spacers or splints worn at night
- Stretching and strengthening exercises for the foot
- Anti-inflammatory medication for flares
- Cortisone injection in selected inflamed cases
Surgical care
Bunion surgery is the only way to actually correct the deformity. It is appropriate when pain limits daily activities, when the deformity is progressing, or when conservative measures have failed. There are more than 100 named bunion procedures — we choose the one that fits the specific anatomy of your bunion based on weight-bearing X-rays.
- Minimally invasive bunionectomy — small incisions, faster recovery, used in selected cases
- Distal osteotomy (chevron, scarf) — bone cut at the metatarsal head to realign the joint
- Lapidus procedure — fusion of the joint at the base of the metatarsal for larger deformities or hypermobile feet
- Akin osteotomy — additional toe-bone cut often combined with the above
- Joint fusion for severe arthritic cases
Modern bunion surgery typically allows protected weight-bearing in a surgical shoe or boot immediately. Most patients are back to athletic shoes by 6–8 weeks and back to normal shoes by 3 months. Return to running or sport is usually 3–4 months. The exact timeline depends on the specific procedure — we walk through it in detail before surgery is scheduled.
When to see a specialist
- A bunion that is becoming painful in regular shoes
- Difficulty finding shoes that fit comfortably
- A bunion that's clearly getting bigger over time
- The second toe beginning to lift, cross over, or develop a hammertoe
- Pain that interrupts walking, work, or sleep
Bunion evaluation can be done by any of our board-certified podiatrists across our 8 clinics. Surgical correction is performed by Dr. Mia Horvath and Dr. Thomas Melillo at our Tigard Locust office. Both are surgical podiatrists with extensive bunion correction experience and a measured, conservative-first philosophy — they will tell you honestly whether you need surgery now or whether a non-surgical plan still makes sense.