The Problem With Bunions

A bunion, also known as hallux valgus, is a painful deformity that develops at the base of the big toe, New York Times reports. Bunions are caused when the big toe pushes and bends inward towards the other toes. This displaces the bones of the joint, causing it to protrude in a way that looks like a large growth.

Bunions develop due to a variety of factors. Some people inherit feet that are more susceptible due to their shape and structure — having flat feet for instance.

But bunions can be made worse by the wrong shoe, or by carrying extra weight or prolonged periods of standing or walking.

Dr. James P. Ioli, Chief of Podiatry at Brigham and Women’s Hospital in Boston, said wearing the correct shoe size is a good first step in preventing bunions. It’s important to make sure your toes have enough room. Don’t wear shoes that jam the toes together. High-heels are also particularly bad because they move the body’s weight forward and change the mechanics of the foot.

“In my 30 years of doing this I’ve been asking when’s the last time you’ve had your foot measured in reputable shoe store,” said Dr. Ioli.

Even if you think you know your shoe size, Dr. Ioli said, the size of your foot can change over time. In a woman’s foot, the ligaments often relax after having a baby, causing the foot to get longer and wider.

It’s important to make sure your toes have enough room and not wear shoes where they are jammed together. High-heels are also particularly bad.

Unfortunately, there are not really any effective non-surgical options to reduce the size or reverse the development of a bunion, said Dr. Ioli.  But non-surgical treatments can reduce the pain or discomfort from a bunion and keep it from worsening.

If a change of footwear doesn’t help, a shoe stretcher may be able to alter a pair of shoes by stretching the part of the shoe around the bunion to make more room. Silicone or felt pads worn on the feet or as shoe inserts may also relieve pain. But, Dr. Ioli said, what works will vary on a case by case basis. Massages, stretching, splints, anti-inflammatory drugs like aspirin, ibuprofen and sometimes steroid injections may also help.

If the right shoe and conservative treatments don’t go far enough and the pain is severe, then surgery might be necessary. How to decide? Dr. Ioli suggested rating your pain on a scale of 0 to 10.

“If they’re a seven, eight, nine then we’d talk about surgical treatment,” Dr. Ioli said. “If it’s a three or four we say try conservative treatment for six months or a year.”

Because surgery carries risk of complications and prolonged recovery, Dr. Ioli said they would never operate on a bunion for purely cosmetic reasons.

There are a range of different surgeries that can be performed with the goal of realigning the joint and relieving pain ranging from shaving off part of the bone to cutting and realigning the bone with pins and screws. Depending on the surgery full recovery can take months and require you to stay off the foot.

One new type of surgery, called a tightrope, involves attaching a wire to the bone to try and pull it back into alignment, but Dr. Ioli said to be wary of this procedure because there have not been any long-term outcome studies yet.

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