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What Causes a Bunion - San Francisco Podiatrist Explains

What is  bunion? San Francisco Podiatrist explains in this transcript from the educational bunion video series. As a bunion surgeon and podiatrist in San Francisco, one of the most common questions I get is…”What exactly is a bunion?” In this short video, you will learn how a bunion forms, as well as some tips on making sure it doesn’t get any more painful. 

To begin with, a bunion is a bump at the inside of the foot at the base of the big toe. You can see that bump here at the base of the big toe on the left side of the foot.  

And its right at the big toe joint that the bump we call a bunion forms. So instead of just showing you images of feet with bunions (like this one that I took a picture of just before I removed the bunion in surgery) I think it may be best to explain how it all happens.

To help you understand what a bunion is, I have drawn some images of feet illustrating the bones that are involved with bunions. In this first image you can see that the bones in the toes line up with the bones in the foot. The long bones in the foot are called the metatarsal bones. The first metatarsal bone is the foot bone that moves over and sticks out causing the bunion to form. 

But in the early development of a bunion, the first thing someone will notice is that the big toe starts to tilt over and bump up against the second toe. The problem is that as the toe leans over, it actually pushes the metatarsal bone outward forming the bump on the inside of the foot. So really a bunion is a bump caused by BOTH the big toe leaning one way and the first metatarsal bone leaning the other way.

When the metatarsal bone pokes out like this, it protrudes and gets rubbed on the inside of the shoe and becomes irritated. Sometimes a large knot of bone grows on the head of the metatarsal bone, making the problem in worse. 

All of that friction causes the skin and the joint capsule under the skin to become irritated. In response, the soft tissue actually gets thicker. Then its sort of like when you smash your thumb, it seems just big enough to bump it on everything.  With enough irritation, the bunion becomes inflamed, red and painful. 

At that point, it becomes painful to wear many types of shoes. Now, obviously high heeled shoes that are pointy and cramp the toes cause bunion pain. But also in the Bay area, there are lots of outdoor enthusiasts that suffer with bunion pain. For example, cyclists with bunions have a really tough time, because most cycling shoes are tight and not very forgiving when you have bunions. Hiking boots can also cause bunion pain. Most backpacking boots are made of supportive leather, but they are very stiff and won’t give very much. Really, any kind of shoes that push against the bunion can lead to pain.

Once someone realizes they have a bunion, they seem to want to know, “Will it get worse?” Well, in most cases, bunions are a progressive deformity. They will slowly get worse over time. 

The one time when they get rapidly worse is when bursitis develops. You have a little fluid filled sack called a bursa lying under the skin thats there to protect the joint. But if you stick that foot with a bunion in the wrong shoe, you can irritate the bursa. Then you get a case of “Bursitis” which is simply inflammation of the bursa. And when bursitis flares up, the bunion really swells. It turns big, red and seems feels like it grew bigger overnight. 

If you have started to notice a bunion, especially one with some bursitis, there are several things you can do yourself to help alleviate any pain. at the big toe joint.

TIPS for Painful Bunions: 

Avoid shoes that rub on the bunion. Its no co-incidence that many people who have bunion removal surgery have been wearing nothing other than sandals for year. Sandals don’t push on the bump. And generally, if you don’t pusk on the bump, the bunion won’t hurt. So try some sandals or wider shoes. Often times this can help.

If the bunion becomes red and inflamed, Ice it. Try applying ice for 15 minutes to help decrease the inflammation. 

Over-the-counter anti-inflammatories (NSIADS) like ibuprofen, Motrin, naproxen or Alleve can often help reduce the pain and inflammation, but don’t ever start taking these until you have talked with your foot doctor first. 

You can also try some pads to reduce the pressure from the bunion when you’re wearing shoes. Obviously most people can’t wear sandals everyday, particularly in some place like San Francisco where its cold. However, by putting some pads on the right places on the bunion, you can reduce the pain and irritation. The goal is put pressure around the bunion instead of where it hurts. Don’t just put a piece of moleskin on it. You need to find a pad that is either horseshoe shaped or has a hole in it so that when you put the pad on the bunion, you can actually see the painful irritated area in the center of the pad. This will put the pressure around it and decrease the pain.

If you try these treatments and it doesn’t get better, seek help from podiatrist who specializes in bunion treatment. 

You don’t have to live with painful bunions. There are many surgical treatments and non-surgical treatments available for bunions. At Doc On The Run San Francisco House Calls Podiatry, we specialize not only in bunions, but also in making housecalls for busy people in San Francisco who just don’t have the free time available to make it to the doctor’s office. 

You can view the video to learn more about bunions and their treatment by clicking. 

Dr. Christopher Segler is a bunion surgeon in San Francisco. His is the inventor of the patented Tarsal Joint Distractor that is used by foot surgeons to simply bunion surgery procedures.  He has also published research teaching other bunion surgeons how to reduce pain after elective foot surgery like bunion correction surgery. He practices surgical podiatry in San Francisco. 





What is a Bunion

Bunion picture from San Francisco's Podiatrist

A bunion is a nothing more than a bump or enlargement of the bone and joint at the base of the big toe. This joint is called the first metatarsophalangealjoint (MPJ). A bunion forms when the joint becomes misaligned and the bone or soft tissues at the big toe joint start to move out of place. What happens is that the big toe starts to bend over toward the other toes. This causes the bone to stick out. The soft tissues that are covering that bone then becomes irritated red and inflamed. This causes a painful knot of bone. Because this joint carries the majority of the body´s weight while walking, bunions can become extremely painful. Eventually the big toe joint itself may become arthritic, stiff and sore. This can make walking and fitting into shoes extremely difficult.

Diagnosis of a Bunion

When you suspect you have a bunion, your doctor will begin by taking a history of your condition to make she he has the full story. A physical exam will also be performed to determine the condition of the big toe joint, note any associated deformities, and evaluate the biomechanics of your foot. Xrays are usually performed as well to help evaluate the extent of malalignment of the bone and to look for arthritis. 

These tests are usually sufficient for your surgical podiatrist to get an idea of the treatment that will be required. The results of all of these tests are typically explained on the first visit so that you can get a full understand of how bunions begin, what you can do to fix your bunions, and the bunion treatment that will be most appropriate on your case.

Bunion Treatment

Some bunions can be  managed without surgery, and foot specialists emphasize that prevention is always best. To minimize the chance of developing a bunion, choose shoes that have square/flared toe ends. Shoes, which are short, tight, or sharply pointed must be avoided. No other primate suffers from bunions as homo sapiens is the only species that wears shoes.

Bunion Surgery
 Bunion Surgery San Francisco

When is bunion removal surgery needed?

Non-surgical treatments of bunions focus on relieving pressure and irritation of the bump at the base of the big toe, but generally will not correct to deformity of the big toe joint. Some of these include various footwear like gelled toe spacers, bunion / toes separators, bunion regulators, bunion splints, and bunion cushions. When someone has bunion pain and would like to have the toe straight again, surgery is the main treatment for bunions since it is a fixed bony deformity. 

Do Shoes Cause Bunions?

 Do High Heel Shoes Cause Bunions


Do Shoes Cause Bunions? 

As a foot surgeon, one the most frequent questions I get is "Do shoes really cause bunions?" The fact is shoes do not cause bunions; genetics cause bunions. If you have bunions you likely inherited them from your mother, father or grandparents. If you take a close look at the feet at a family gathering you can likely figure out who gifted you with the genes that led to your bunions. 

How to Find a Qualified Bunion Surgeon

Thinking about surgery, whether bunion surgery or brain surgery, can be a potentially stressful and serious decision. It is obviously important that you, as a patient considering surgery, make the right decision. If you know which questions to ask, you should have no trouble finding a well qualified foot surgeon who can remove the bunion, relieve your pain, and get you back to all the activities that help you enjoy life on your feet. 

Keep in mind that there are many well qualified doctors in almost every area of the country (including the San Francisco Bay Area) who are capable of successfully performing your bunion surgery.  The goal is to help you discern the valid qualifications from the dubious ones.  In this way, you should be able to determine for yourself, whether or not the surgeon you have chosen is likely to provide you the outcome you want...no bunions and a return to the activities that make life enjoyable.

This is the area where most of the confusion lies. In the United States, the foot and ankle surgeons with the most hours of foot surgery training, who are held to the highest standards and who also have the most rigorous board qualification testing are affiliated with the American Board of Podiatric Surgery. So the confusing part is that there are many other “board certifications” such as the "American Board of Multiple Specialties in Podiatry" and the "American Board of Foot Surgery."  While these "alternate boards" might sound official, they are very rarely accepted as any sort of proof of surgical skill or competency by the hospital committees that grant surgical privileges.

Board Qualification

This is the area where most of the confusion lies. In the United States, the foot and ankle surgeons with the most hours of foot surgery training, who are held to the highest standards and who also have the most rigorous board qualification testing are affiliated with the American Board of Podiatric Surgery. So the confusing part is that there are many other “board certifications” such as the "American Board of Multiple Specialties in Podiatry" and the "American Board of Foot Surgery."  While these "alternate boards" might sound official, they are very rarely accepted as any sort of proof of surgical skill or competency by the hospital committees that grant surgical privileges.


Your foot surgeon should have three years of surgical training in a foot and ankle surgical residency after graduating from medical school. The more training, the more experience with a wide range of surgical methods and techniques. They say doctors are “in practice,” and the more practice your surgeon has the better.


Make certain your surgeon has experience with medical research, (particular in the areas of your particular problem). This will help to ensure an interest in finding ways to perform surgery better.  A long history in practice by itself is not enough to indicate that your foot surgeon has the advanced skills you are looking for. Medical research separates leaders from followers.  The leaders of course stay out in front, searching for the latest innovations in surgical technique.


Less than 1% of all surgeons (in any specialty) will have won awards for advancing their particular field.  If you find an award winning surgeon, you have likely found the best of the best. Check your surgeon's website or search the internet for evidence of awards indicating they are at the top of their specialty.


Surgery is both a science and an art form. A very useful trait in a surgeon is to creatively identify new solutions to surgical challenges. Look for a surgeon who has demonstrated innovative thinking such as patenting a surgical instrument or technique that can improve the outcome of the surgery.



As we all know, the word “authority” starts with “author.”  Those who write books, publish articles in medical journals and work to share knowledge and educate other surgeons are always staying on top of their game.  A little searching of the surgeon’s name on Google, will reveal a great deal.  If they are a winner, you will have many hits. 

Although selecting the right surgeon can be stressful, keep in mind that you are simply taking the first step to getting better. With the right surgeon, your foot surgery should be a great experience because it signifies the beginning of your recovery, as well as the beginning of a renewed more active and enjoyable life. The time you invest to research your surgeon's qualifications will be time well spent. 


Dr. Segler is a San Francisco based bunion surgeon and a true bunion surgery expert.  He was awarded a patent from the U.S. Patent office for creating the "Tarsal Joint Distractor" which is the best surgical instrument used in the correction of complicated bunions. He has published research teaching other foot surgeons about his methods to decrease pain after bunion surgery.  He has also presented original research related to bunion surgery at prestigous medical conferences in the United States, Canada and New Zealand. He has served as a peer-reviewer for the "Journal of Foot and Ankle Surgery" as well as the "Journal of the American Podiatric Medical Association."  In addition, Dr. Segler has won multiple awards from the American College of Foot and Ankle Surgeons and the American Podiatric Medical Association for his medical research related to foot and ankle surgery. If you have painful bunions that may involve surgery, you can feel confident in the quality of care you will receive from San Francisco's bunion surgery expert.  If you have a question about bunion surgery, you can reach him directly at (415) 308-0833.

Why Do Bunions Get Worse?
Bunions are a progressive deformity. This means that they will typically get worse over time. It is true that the foot becomes more unstable as the bunion gets bigger.  This means that it will often get worse at faster rate over the years. Having said that, it is unpredictable as to just how fast the bunion will become intolerable. As a general rule, bunions are a surgical problem. However, you should only have your bunion surgically removed if it is painful or interfering with the activities you enjoy. Once you start to picture what your life would be like if you had no bunion pain, that it is when it makes sense to talk with your foot surgeon about fixing the problem.
Why Do Bunions Hurt In Winter?
Why Do Bunions Hurt In Winter?

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