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Ask the doctor: ‘I have a bony bump on my foot that hurts when I exercise. What could it be?’


A bunion is a bony deformity of the joint at the base of the big toe

A bunion is a bony deformity of the joint at the base of the big toe

A bunion is a bony deformity of the joint at the base of the big toe

Q: I’ve developed a bony bump on my foot, which I think is a bunion. I’m a 36-year-old man and don’t have any family history of them and don’t wear tight shoes. It doesn’t really bother me unless I exercise or put strain on it, like if I’m doing lunges in the gym. But I do notice it bothering me more and more, and I’m worried that it will get worse. Is there any way to treat it that doesn’t involve surgery, or to stop it from getting worse at this stage?

Dr Grant replies: The bony bump on your foot may be an early onset bunion (hallux valgus deformity). I presume you noticed a protrusion at the base of the big toe or what’s known as the first metatarsophalangeal (MTP) joint. One of the most common signs of a bunion is inflammation, which typically causes pain, redness and swelling over the medial (inner) bursa protecting the MTP joint. A bunion is a bony deformity of the joint at the base of the big toe that causes the big toe to move towards the smaller toes. The degree of movement or angulation of the big toe helps define the severity of the deformity.

The exact reason why bunions form is poorly understood and is thought to be multifactorial, with family history and tight/ill-fitting footwear being two significant contributing factors. Foot anatomy, joint hyper-flexibility and foot biomechanics are also likely to play a role. Interestingly, bunions are rarely seen in parts of the world where people go barefoot. Other contributing factors include having an underlying diagnosis of rheumatoid arthritis, psoriatic arthritis and/or gout.

Certain anatomical factors can increase the pressure under the first MTP joint and force the bone to move in a way that exacerbates the deformity. You have already identified one aggravating factor, doing lunges in the gym, so I suggest you refrain from that activity for the time being. This might mean it causes you a little pain, discomfort or swelling after that exercise. Another aggravating factor is running. Have you taken up running recently? Runners can experience pain/swelling in this joint when running long distances or after switching to a new brand/style of runner.

For anyone over 50, early degenerative changes (osteoarthritis) could be a cause for the bony bump. Osteoarthritis (OA) of the first MTP joint (big toe) is common. Early OA changes can be seen on an MRI scan, and more established OA will be noted on a foot X-ray. A foot X-ray allows the bony structure of the foot to be clearly seen as well as the degree of movement and deformity caused by the bunion. But the majority of people with a mild bunion do not warrant X-ray or other imaging.

There are plenty of conservative options for managing bunions, although in clinical trial settings none of these have been shown to give any statistically significant efficacy. These include wearing wide-fitting footwear, placing orthotics in your footwear or wearing splints at night. Surgical correction is generally only considered for severe deformity or those in severe pain.

In your case, I think it would be a good idea to attend a physiotherapist for an assessment of your foot anatomy, arch, biomechanics and overall gait.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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