Bunion surgeries have been performed for more than 100 years. Techniques used today now ensure minimal pain, faster recovery and earlier and improved mobility; and they can decrease the likelihood that a bunion will return later in life.

A bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. This enlargement represents extra bone formation combined with a misalignment of the metatarsophalangeal (MTP) joint at the base of the big toe. The normal straight position of the big toe becomes distorted causing the big toe to turn outward bending toward the smaller toes and causing a painful bump on the foot. Since this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The joint itself may become stiff and sore, making wearing shoes difficult or impossible.

Bunions occur most commonly in women. Some studies report that bunions occur nearly 10 times more frequently in women than men. Bunions are also more prevalent in people who wear shoes than in barefoot people. More than one in five American adults currently suffer from bunions, and upwards of two-thirds will develop a bunion in their lifetime.

Bunions form when there is an imbalance of the forces on the joints and tendons around the foot. This leads to instability in the joint and the deformity after years of abnormal motion and pressure. This faulty foot mechanics caused by the way we walk, inherited foot type, shoes or other sources result in bone and joint deformities such as bunions. Although bunions tend to run in families, it is the foot type and foot mechanics that are passed down, not the actual bunion. These genetic factors can predispose one to developing bunions.

Tight-fitting shoes, especially high-heels and narrow-toed shoes, increase the risk of bunions, which explains the high numbers in women. People who have flat feet, low arches or arthritic or inflammatory joint disease are also more prone to developing bunions. Ballet dancers and others with jobs that place stress on the feet also increase the risk of developing bunions.

Symptoms

Bunions may or may not cause symptoms. A common symptom is foot pain when walking or wearing shoes that is relieved by resting or taking off the shoes. Bunions can cause pain plus swelling and redness. A small fluid-filled sac called a bursa can also form next to the joint. Other symptoms of a bunion may include a firm bump on the foot, at the base of the big toe, corns or other skin irritations caused by the overlapping of the first and second toes, restricted or painful motion of the big toe joint and difficulty finding, fitting and wearing shoes.

Treatment

Self-treatment will not take the bunion away but can give you relief from its symptoms. Changing the type of shoes worn can definitely help — wear shoes that have more squared or rounded mouths with a wider and deeper toe box (front of the shoe) to accommodate the bunion. You can apply commercial, non-medicated bunion pads around the bony prominence to relieve the pressure in shoes. If your bunion becomes red and painful, place ice packs on it several times a day to reduce the swelling. Avoid shoes with heels over two inches tall and see your podiatrist if the pain persists.

Conservative treatment for bunions

Treatment options vary with the type and severity of each bunion. Identifying the deformity early in its development is important for early treatment and to avoid surgery. Non-surgical treatments involve simply resting the foot by avoiding excessive walking and wearing loose (wider) shoes or sandals that can relieve the pain. Sneakers are more comfortable and provide an advantage over high-heeled shoes that push the big toe outward, making the deformity worse. The goal of early treatment is to relieve the pain and pressure on the bunion and slow the progression of the deformity. The podiatrist may recommend all or any of these treatments.

Padding and taping: Padding the bunion minimizes pain and allows the person to continue a normal, active life.

Medication: Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by the bunion.

Physical therapy: Therapy such as ultrasound can provide relief of the inflammation and pain from the bunion. Stretching exercises can also reduce tension on the first metatarsophalangeal joint. A bunion splint is usually worn at night and can provide further relief and slow the deformity.

Orthotics: Shoe insoles may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity. When these strategies are effective in relieving symptoms, the patients should continue to use them and avoid irritating the bunion.

When to see the podiatrist: If you have a bunion, you should see a podiatrist at the first indication of pain or discomfort. If untreated, bunions tend to get larger and more painful.

Surgical options: When early treatments fail, or for those bunions that cause persistent pain, surgery is the option. The procedure is called a bunionectomy. Several types of procedures are available that will remove the bump, restore the normal alignment of the toe joint and relieve pain. A common misunderstanding among patients considering bunion surgery is that they won’t be able to walk for weeks or months. But the reality is that bunion surgery has changed dramatically in the last 10 years and the recovery time is often four to six weeks.

• For more information email foothealth242@gmail.com or visit www.foothealth.org, apma.org or orthoinfo.aaos.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates on Albury Lane telephone 394-5820.