Bunions: A bunion (hallux valgus) is a deformity at the base of the great toe joint with a prominent bump and the big toe is angled towards the second toe. The deformity may cause the foot to rub on the shoes, which may cause inflammation and pain. Good footwear is often all that is needed to ease the symptoms. Surgery may be an option for more severe cases. In addition there is often thickening of the skin and tissues next to the big toe joint. The thickened skin and tissues may become inflamed, swollen and painful. Sometimes a fluid-filled sac (bursa) develops over the joint. In most cases it is not completely clear why a hallux valgus-bunion deformity develops. There may be some hereditary (genetic) component based on the way one's bones and joints are shaped thus effecting the way one walks causing weakness of this joint. In some cases bunions can be associated with diseases that effect the joint such as osteoarthritis or rheumatoid arthritis. Research has demonstrated that wearing tight, badly fitting high heeled shoes tend to make the bunion worse. Wearing such shoes puts extra pressure on the big toe joint and causes friction on the overlying skin. Wearing good footwear does not cure the deformity but may ease symptoms of pain and discomfort. Treatment may consist of wearing supportive shoes with a wide and high toe box to allow room around the big toe, lace up shoes which allow one to adjust the pressure over the foot and avoid high heeled shoes greater than 1.5" in height. Bunion splints, toe spacers and gel guards often can be worn when sleeping or in one's shoes during the day to help take some pressure off of the deformity and slow down the progression, but there is no evidence they improve the underlying condition or stop it from getting worse. Medications such as non steroidal anti-inflammatories or steroids may help reduce inflammation and pain and mild narcotics to just address the pain, but long term use of any of these medications may cause temporary or permanent liver and kidney side effects. Surgery is the last resort to attempt to lessen the pain and improve function, activity level and the quality of life. Surgery is usually successful at easing symptoms but not in all cases. It is not always possible to relieve the pain completely or make the toe perfectly straight. A few common complications of surgery can include continued pain, stiffness, numbness, bunion recurrence, infection, prominent scar with irritation especially in shoes and complications associated with anaesthesia.