Patient Education

Bunions

Description

You may have noticed that podiatry people are not big fans of the kinds of shoes that some people go nuts over: sharply pointed toes, heels that come up higher than the knees, you get the picture. However, the reason for this is not that your podiatrist has an evil plan to make you as unfashionable as possible. It’s simply that the shoes considered fashionable are often the same shoes that can seriously aggravate numerous foot problems.

Take bunions. Now, bunions aren’t actually caused by wearing poorly-fitting shoes, but they do make an already tough problem much worse. Bunions are actually caused because of inborn misalignments within the foot. These inherent structural problems with the foot will place more stress than usual on the joint where the big toe connects with the 1st metatarsal (the long bone that attaches to the big toe and stretches down the length of the middle of the foot). Eventually, this stress may cause the tissues around the joint to stretch and become less supportive, thereby leading to further misalignment of the bones. Eventually, the metatarsal starts jutting towards the inside edge of your foot, and the big toe begins to point toward the other ones. This often results in a bump on the inside edge of your foot right next to the big toe.

And those aren’t the only problems that might crop up. Some people develop bone growth on the joint; others (although this is rare) acquire a fluid- filled sac over the bunion called a bursa. But the problem many of you may be most interested in is that bunions may make it difficult or even impossible to wear shoes. The truth is that ill-fitting shoes are often the things that turn bunions from juvenile delinquents into outright criminals. Shoes with tight toes, or pointed heels, may put even more stress on an already stressed-out toe joint, further aggravating the misalignment of the foot. The good news is that sometimes giving up those pointy, high-heeled shoes may make your bunion problem much easier to bear. But, more on that in a moment.

Symptoms

People with bunions will usually decide they need to go in to see a podiatrist when it becomes painful to wear shoes. Often, these people are women, whose forays into the world of fashion have brought them additional foot pain, although bunions may become aggravated simply from being on one’s feet a great deal.

Pain will likely occur where the bunion is located (i.e. at the base of the big toe). You may also notice a firm bump developing on the inner edge of your foot, next to the big toe base. In some cases, the big toe leans visibly in towards the other toes, which may lead to sores forming between the toes as they’re squeezed together, calluses forming on the big toe, corns popping up on the big or second toe, and the accumulation of massive amounts of toe jam. (Well, just kidding about that toe jam part.)

The area may also become inflamed, which means swelling, redness, and possibly skin that’s warm to the touch. Moving the joint may also become more difficult. If the bunions are particularly bad, some people may find it difficult or even impossible to walk.

Diagnosis

Your podiatrist has probably seen a lot of bunions already. To diagnose yours, he or she will likely look for the characteristic bump on the side of your foot next to the big toe joint, and may check for or ask you about some of the above symptoms. X-rays may be ordered to provide a firm diagnosis, and to tell your podiatrist exactly how far the deformity has developed.

Treatment

Bunions aren’t a problem that will simply disappear with time, although there are things you can do to help prevent the problem from getting worse, and to make yourself a lot more comfortable.

First of all, get rid of the darn high-heels and pointy-toe shoes. Seriously. The best shoes, especially for people with bunion problems, have toe boxes (the space for toes at the end of your shoe) that accommodate all of your toes (not just the ones fashion says you should have), and enable them to move around a bit. Also, avoid heels that are higher than an inch or two (the lower the better). For some people (although not everyone), this may be all you need to do to rid yourself of the pain associated with bunions.

However, many people will find that they need more extensive treatment. If you’re in this boat, there are a few things you can try. Sometimes putting felt or over-the-counter bunion pads on your bunion will reduce the pressure on the prominence and provide considerable relief. Taping the foot (you can ask your podiatrist how to do this properly) may also help hold things in proper alignment, thus reducing the stress on your joint.

You can reduce the inflammation associated with bunions by applying ice for twenty minutes an hour (always use a thin towel between ice and your skin), or by using anti-inflammatory medications such as ibuprofen. (Your podiatrist may occasionally prescribe a more potent anti-inflammatory oral or injected medication.) Some people also find that physical therapy (specifically ultrasound therapy) may reduce bunion pain. If deemed appropriate, orthotics may be used to try to correct the original misalignment that caused the problem.

Unfortunately, sometimes the above treatments don’t correct the problem enough to enable you to live without significant pain. If that’s the case, then it may be time to discuss surgical options with your podiatrist. There are over one hundred surgeries that have been used to correct bunion problems. Your podiatrist will discuss the option that best suits your particular problem, taking into account your lifestyle and other medical needs.

Some surgeries (bunionectomies) simply remove the bony growth from the joint. This is more typically used with less severe cases. In other surgeries, the metatarsal may be cut and the bones realigned into proper position using screws, pins, and plates to keep everything in the right place. Usually this also involves fixing any soft tissue problems that may have developed along with the bunion, such as tendon problems.

Whatever the treatment you use, be sure to follow the advice of your doctor. Doing so will make it much less likely that your bunions will return to haunt your life again.