Bunions are one of the surprises of middle age. Who would ever suspect that the funny bumps on Grandma’s feet would suddenly appear on our own?
It’s thought there are known causes of bunions— such as tight shoes— but we usually fail to notice anything wrong (or give it a second thought) until suddenly it hurts to wear shoes and we find we’re limping around on blistered feet.
If you suspect but you’re not sure whether you have a bunion, here’s what to look for. It’s a swollen knob at the base of the big toe. It may become red or tender over time. If not treated, it can lead to bursitis, arthritis, hammer toe or crossover toe.
A bunion is an enlargement of the joint at the base of the big toe that’s caused by misalignment. This forces the big toe to bend towards the smaller toes. Less often, a bunion may develop at the base of the little toe. This is sometimes called a tailor’s bunion or bunionette. (The reason for the nickname is that long ago, tailors sat cross-legged all day with their baby toe rubbing against the ground.) We see a fair number of patients who only become aware of a problem when they can’t find comfortable shoes.
Bunions Are Major Cause of Aching Feet
At our clinics in DeSoto, Dallas or Sunnyvale, we see many patients with bunions in various stages of development. Very often, a patient’s biomechanics are a factor. Overpronation, for instance, when the foot rolls outward as you walk, has been associated with bunions, hammer toe and crossover toe.
While shoes are not the direct cause of a bunion, some footwear can increase discomfort. Tight shoes, narrow toe box, high heels … all have been linked to increasing the pain and disability associated with bunions. Bunions are common in ballet dancers, whose work entails standing en pointe in tight-fitting shoes. (At the clinic, we recommend supportive footwear with arch support, exercising the mid-foot, and taping and padding the inside of the shoe to keep ballet dancers’ toes aligned.)
By the way, women are more apt to be afflicted with bunions— ten times as frequently as men.
Some patients, especially younger people who develop bunions, may have a hereditary disposition. An abnormal shape of the foot or arthritic disease such as rheumatoid arthritis can lead to bunions.
Bunion Surgery An Option
If conservative treatment is not working, we may recommend surgery. In some cases, we can trim the bone to relieve pressure. Other patients may be treated with relignment to stabilize the bone.
Some 85% to 90% of patients who have bunion surgery report significant relief. That is the goal. If the patient can resume walking and running without pain, we consider treatment a success.
Post-surgical patients should guard against developing another bunion. Often the original problem was caused by biomechanics— i.e., the gait or physiology of a person’s foot. If the patient resumes wearing shoes that cause a problem and nothing has changed biomechanically, the bunion could reappear. This is discouraging for patients who’ve traveled the long road from diagnosis to conservative treatment to surgery to rehab— only to be told they should start at the beginning again.
We tell our patients that we are in this together— surgeon and patient. Patients are provided with bandages, braces and other supports. They may be advised to use a walker, cane or crutches for a few days. While the surgeon is critical to treatment success, he or she cannot do it without the active participation of the patient.
Much strength and range of motion can be restored with physical therapy. You may also be prescribed an antibiotic to ward off infection. As foot and ankle surgeons, we have a great stake in seeing you walk out of our clinic with a confident and healthy stride.