We have all heard horror stories about Great Grandma Wilson and her bunions. They were horrible, ugly, disfiguring and she was hobbled by the time she was 50. But if someone asks us “what is a bunion”, we’re hard pressed to provide an answer. Here’s the scoop.
Have you ever seen anyone who has a bump on the side of the big toe joint? If the answer is yes, then you have seen a bunion. Sometimes it is a small bump and other times the bump is accompanied by the big toe drifting under the lesser toes. Often times a bunion is thought of as a growth on the side of the foot and removing the growth would solve the problem. Like most things, it is not that simple. Typically, a bunion deformity is the result of the first metatarsal bone (long bones of the foot) drifting away from the lesser metatarsals. The bump is actually the joint sitting in an abnormal position. Several things contribute to bunions but only occasionally is it the result of wearing high heels or pointed shoes. Typically we inherit the predisposition to develop bunions. Arthritic conditions, injuries, neuromuscular diseases or lower extremity structural problems may also result in the development of bunions.
So, how do we treat it? Unfortunately, there are no braces, splints or exercises that will coax the bone back into position. Orthotics may slow the progression but has not proven to stop it. If someone has had symptoms for a short time or the pain began with a specific shoe or activity, I usually recommend anti-inflammatory medications, steroid injections and/or avoidance of the shoe culprit. Occasionally, bunion shields or pads will relieve the pressure, allowing the symptoms to subside.
If conservative measures fail, surgery is indicated. There are several different procedures and the choice depends on the severity of the bunion and the presence or absence of arthritis. Usually, bunion surgery requires fracturing and resetting the first metatarsal bone and can take from 6-12 weeks to heal. This surgery is usually very successful but should only be performed on people who are having pain that affects their ability to work or play on a consistent basis. Poor cosmetic appearance or occasional pain are usually insufficient reasons to recommend surgical intervention. Young women often ask me “shouldn’t I have it fixed now so that I won’t have problems later?” That is a difficult question. The answer is usually, but not always, no. Bunions are a progressive deformity but we cannot predict the rate at which they will worsen. If you have these questions, have your foot evaluated by your podiatrist and discuss your options.