A bunion bump on the side of the foot behind the big toe is actually a deviation of the longer bone within the foot called the first metatarsal. Behind the big toe, the metatarsal bones are approximately four inches long. The first moves towards the mid-line of the body, away from the second metatarsal bone. The big toe then falls in the gap, frequently under-lapping the second toe. Secondary soft tissue adjustments occur as the outside of the joint stretches and the inside of the joint contracts.

The deformity continues to progress, frequently causing arthritis, joint inflammation, and changes to the second toe and metatarsal. Such changes include painful hammertoe and a sore place behind the second toe on the bottom of the foot as the hammertoe pushes the second metatarsal down.

Bunions occur more frequently in women, especially in the female side of the family. Bunions in men frequently have arthritis and may be due to occupational hazards. Other victims include people with flat feet and rheumatoid arthritis. Conservative treatment by a foot doctor includes shoe gear changes, custom-made inner soles, pads, shields, and arthritis pills. As the condition is usually irreversible, a surgical procedure is frequently entertained.

There are three levels of deformity/surgery. The first involves a soft tissue release and rebalancing. At the second level, a surgical fracture is created to move the end of the first metatarsal back towards the second metatarsal. Screws or pins are installed. The patient may bear weight within a few days after this procedure and return to work within ten days with restrictions.

The third level involves a large bunion deformity where the entire metatarsal bone needs to be folded at its base and special fixation installed. This last patient has waited too long for surgery and must be non-weight bearing for six to twelve weeks. Consultation should be sought with a podiatrist as soon as the bump appears or the big toe begins to shift to the second toe.