What Happens If You Leave a Bunion Untreated? The Progression Nobody Warns You About

A bunion starts as a small bump at the base of the big toe. It's a minor nuisance — you adjust your shoe choice, maybe buy a wider pair, and move on. Years pass. The bump gets bigger. More shoes don't fit. Pain becomes more frequent. And then the cascade of secondary problems begins.

Bunions are progressive, meaning they get worse over time if the underlying cause isn't addressed. Understanding what happens as they advance can help you make an informed decision about when to intervene — ideally before the simple correction becomes a complex reconstruction.

The Anatomy of Progression

A bunion (hallux valgus) is not just a bump — it's a misalignment of the first metatarsophalangeal (MTP) joint. The first metatarsal drifts medially (toward the midline) while the big toe angles laterally (toward the smaller toes). The "bump" you see is the exposed metatarsal head, not a growth of new bone.

As the angle between the metatarsal and the big toe increases, several things happen progressively.

Stage 1: Mild Deformity — Occasional Pain

The bump is noticeable but small. Pain is intermittent, usually triggered by specific shoes or prolonged walking. The big toe still functions normally. At this stage, conservative measures — wider shoes, toe spacers, padding, and orthotics to control pronation — can effectively manage symptoms and may slow progression.

This is also the ideal time for surgical correction if it's needed. The deformity is mild, the joint is still flexible, and the correction is straightforward. Minimally invasive bunion repair at this stage involves small incisions, minimal tissue disruption, and a rapid recovery — walking the same day.

Stage 2: Moderate Deformity — Consistent Pain

The bump is prominent. Pain is more frequent and limits shoe choices. The big toe begins pushing against the second toe. The bursa (fluid-filled sac) over the bump becomes chronically inflamed. At this stage, you notice something important: the problems are no longer limited to the bunion itself.

Hammertoe formation. As the big toe pushes laterally, it crowds the second toe, which buckles upward into a hammertoe. The hammertoe then develops its own painful corn on top from shoe friction and a callus on the ball of the foot from altered pressure distribution.

Metatarsalgia. The misaligned first metatarsal no longer carries its share of the body's weight. The load transfers to the second and third metatarsal heads, which aren't designed for it. The result: pain and calluses under the ball of the foot — a condition called transfer metatarsalgia.

Bursitis. The inflamed bursa over the bunion becomes thickened and chronically painful, making even soft shoes uncomfortable.

Stage 3: Severe Deformity — Multiple Problems

The big toe may overlap or underride the second toe. The joint becomes stiff with arthritis. Finding any comfortable shoe becomes genuinely difficult. The secondary problems — hammertoes, metatarsalgia, calluses — are now conditions in their own right that need treatment.

Arthritis of the MTP joint. Years of abnormal joint mechanics erode the cartilage. The joint becomes stiff, swollen, and painful with each step. Once significant arthritis develops, the joint cannot be fully restored to normal — surgical options shift from joint-preserving corrections to joint-limiting procedures.

Gait changes. To avoid loading the painful big toe joint, you alter how you walk. You may roll to the outside of the foot, shorten your stride, or shift weight to the opposite leg. These compensations cause secondary pain in the ankle, knee, hip, or lower back.

Balance impairment. The big toe plays a critical role in balance and push-off during gait. A severely deviated, stiff, or arthritic big toe compromises both, increasing fall risk — particularly concerning in older adults.

The Key Insight: Earlier Is Simpler

Correcting a mild bunion is a relatively simple minimally invasive procedure with rapid recovery. Correcting an advanced bunion with arthritis, hammertoes, and transfer metatarsalgia is a more complex undertaking — sometimes requiring correction of multiple deformities in the same session. The foot still benefits from surgical correction at any stage, but the surgery, recovery, and outcome are all better when addressed earlier in the progression.

What You Can Do Now

If you have an early bunion, manage it with wide toe box shoes, custom orthotics (which won't reverse the bunion but can slow progression by controlling pronation), and monitoring. If the deformity is progressing or causing consistent pain, an evaluation can determine whether conservative management is still adequate or whether minimally invasive correction while the problem is still simple would save you from a more complex procedure later.

The one thing a bunion won't do is get better on its own. The only question is when — not whether — it will need to be addressed.