What a Bunion Actually Is
A bunion is a progressive 3D deformity. The first metatarsal drifts toward the midline of the body, tilts upward, and rotates inward. The big toe drifts laterally toward the second toe. The visible “bump” is the medial eminence of the first metatarsal head - a symptom, not the cause.
What Drives It
In most patients, the underlying problem is an unstable tarsometatarsal (TMT) joint that allows the first metatarsal to migrate. Family history is the strongest risk factor. Footwear - particularly narrow, pointed shoes - accelerates an existing tendency.
Conservative Care
Wide toe-box shoes, padding, custom orthotics, and intermittent injection for joint inflammation can manage symptoms but do not reverse deformity. Toe spacers and night splints have limited evidence for changing the underlying joint mechanics.
Surgical Correction
When a bunion limits activity, footwear options, or causes secondary problems (hammertoes, second-toe overload), surgery is appropriate. Dr. O’Carroll selects from osteotomy, fusion, and Lapiplasty® 3D correction based on the severity of deformity and the degree of TMT instability - matching the procedure to your anatomy and lifestyle.