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.