Bunions. The mere mention of the word for some remind them of their grandmothers wearing those big, black, boxy orthopedic shoes of yesteryear. I still, to this day, when I’m brave enough and dare to usher the word ‘bunion’ do I get “the look” and subsequent growl of, “I don’t have bunions”! I secretly love uttering those words. If not for anything else, just to see the look on some patients faces.

BUNIONS.
The who, what, where, and whys of one of the conditions that for folks my age and older dread to hear. Most patients fear the word almost as much as hearing they have nail fungus (see a previous article for that discussion). And just saying the word, ‘folks’ is a dead give-away.

WHAT is it?
A bunion can range from a small, painless bump at the big toe joint to an incredibly painful deformity with the big toe sitting either above or beneath the toe next to it. It can be uncomfortable even when barefoot and there is no pressure at that site. Some of the worst bunions I’ve seen, patients deny that they’re painful at all. What can cause the pain can be arthritic changes at the joint, shoe gear pressure, rubbing/ friction, diminished cartilage at either side of the joint, an infection or an inflammation of the bursal sac. This sac is similar to an air bag in a car that prevents further trauma at a particular site. This is different than a gout attack which also occurs at the big toe joint. Another issue altogether.

WHO gets one?
You, most likely. If a family member i.e. father, mother, grandparent, etc has one. There can be a genetic pre-disposition towards developing a bunion. I say can since it’s not a guarantee that you’ll end up with one, especially if you keep mindful of what you do or wear. If you pre-destined, it may manifest itself early on such as in the tweens/ teens ages. This may or may not be painful. If you don’t have one by the time you are in your 20’s or 30’s, you will most likely not develop one due to this reason. This is not a hard and fast rule, but for our sake, we’ll say that it is. And no, neither I nor anyone else can tell you whether you’ll need surgery in X number of years. You may, but then again you may not. Try to prevent it developing while you still can.

Trauma is a likely cause but we’ll stick to natural development of a bunion. Unless, of course, you consider wearing high heels for extended periods of time, trauma. You may not, but your feet and I would, though.

WHY does it develop?
Shoewear. Not all, but most shoewear have a point (humor me for a sec) at the front tip of the shoe usually in alignment with the 2nd toe. Sneakers and boots and most casual shoes are not usually the culprits and are more rounded at this area. It usually is the dressier shoewear that can be to blame. This is the case for both men and women although more so for the latter group than the former. Think high-heeled, narrow, pointed shoes. Yes, ladies you look great in them and it goes well with your outfit, but you pay for it later.

Faulty biomechanics. Biomechanics is basically concerned with the structure and function of the way our bodies work. In particular, the way the bones, joints, tendons and muscles function together in a certain way that produces the most efficient way to perform a certain task. When things are out of alignment due to poor structure, let’s take for example, flat feet and their poor alignment- the feet roll in way too much, or overpronate, causing a misalignment of the long bones of the foot and therefore, the toes and joints. This pushes the big toe towards the 2nd toe increasing the strain along the inside arch area on the side. I am simplifying the process since there are other factors at work here.

TREATMENT:
Not all bunions need to removed or corrected. Yes, reread that. Although some podiatrists and orthopedists would make you think otherwise. Also, it is your decision whether or not to have surgery, or any other treatment rendered to you. You are the one making the decision about how to go about helping your feet feel better. Surgery, may in fact, be the right choice for you, but it is YOUR decision to proceed. It may be just modifying what shoe you purchase that makes the difference. Here is a good rule of thumb that I, for the most part, stand by for most things; if it ain’t broken don’t fix it. Although my wife would say otherwise when it comes to the house. And, if it does need to be corrected, my advice is to be seen by a podiatrist for a thorough evaluation and discussion of your options. All bunions are NOT the same. There are at least 2 dozen types of surgical procedures to correct bunions. Many things need to be taken into account, not just the bump or pain. Feet, it’s what we do all day long, each and every day.

Change in shoe gear-wider is better
NSAID’s
Ice
Pads
Topical pain creams
Cortisone injections
Custom orthotics/ pre-fab inserts
Surgery