A bunion, which is most often blamed on tight, narrow shoes, can become progressively larger, to the point where wearing any type of shoe is painful. Bursitis, an inflammation of the small sac between a tendon and a bone, may set in and your child's big toe may begin to angle toward the second toe, or move all the way under it. The pressure from the big toe could force the second toe out of alignment, sometimes overlapping the third toe.

Most bunions, especially those that affect teenagers, can be treated without surgery.

Although bunions can be an inherited condition that occurs in families, shoes that are too small are the primary cause of bunions, and other disabling foot problems such as corns, calluses and hammertoes. An underlying neurological disorder, such as cerebral palsy, can also predispose a child to developing bunions.

The surgeon will also want to know what kind of shoes your child wears and what types of shoes most aggravate the symptoms. He or she will try to determine whether any pain caused by the bunion is due to specific activities and whether the bunion is causing any functional limitations.

X-ray imaging may be used to help determine the extent of the damage and deformity of the toe joint.

• your child's age, overall health, and medical history
• the extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

• Judge the shoe by how it fits on your child's foot, not based on the size of the shoe. Sizes vary among shoes styles and brands.
• Select a shoe that conforms as nearly as possible to the shape of your child's foot.
• Have your child's foot measured regularly and have both feet measured. The shoe you choose should fit the largest foot.
• Have your child stand during the fitting process and check that there is adequate space ( 3/8" to =") for your longest toe at the end of each shoe.
• Make sure the ball of your child's foot fits well into the widest part (ball pocket) of the shoe.
• Do not purchase shoes that feel too tight, expecting that they will stretch over time to fit.
• Your child's heel should fit comfortably in the shoe with a minimum amount of slippage.
• Walk in the shoe to make sure it fits and feels right.

Souce: American Academy of Orthopaedic Surgeons

Surgery is not recommended for teenagers with bunions unless your child experiences sever foot pain that limits everyday activities and that pain won't subside with non-operative measures, such as shoe modification and the use of an orthotic.

Surgery for cosmetic reasons alone is not recommended. While surgery rarely restores the normal appearance of the foot, it is very effective in alleviating pain and narrowing the width of the forefoot.

There are a number of different types of surgical procedures used to treat bunions. All of the following more common procedures are aimed at relieving pain and correcting the deformity:

• Osteotomy: the surgical cutting and realigning of the joint
• Repair of tendons and ligaments surrounding the big toe: These tendons and ligaments may be tight on one side and loose on the other, creating an imbalance that pulls the big toe toward the others. The procedure to correct this is aimed at shortening the loose tissues and straightening the tight tissues. It is often combined with an osteotomy.
• Exostectomy: Removal of the bump on the toe joint; used only for an enlargement of the bone with no drifting of the big toe.