Blasted Bunions: Is There a Way to Walk without Pain?

Bunions may bring up memories of grandmas and elderly aunts with big bumps on the insides of their feet, but this condition can affect anyone, and can often be so painful that it limits walking and other regular life activities. If you have bunions, what are your options?

WHAT IS A BUNION?
Simply put, a bunion is a deformity of the big toe joint. The 1st metatarsal (first long bone of the foot) deviates inward toward the second toe, sometimes pushing the big toe over or under the second toe. As the big toe drifts, a bump develops on the inside of the foot, over the metatarsal bone—and is often an overgrowth of the bone itself. This bump is called a bunion.

WHAT CAUSES BUNIONS?
Most researchers believe that bunions are hereditary. Studies of primitive tribal people who never wear shoes have found that a small percentage of the population still developed bunions. According to the American Podiatric Medical Association (APMA), bunions are caused when “forces exerted on the joints and tendons of the foot become disrupted….They are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk, and our inherited foot type, our shoes, or other sources.” 
Other causes can include foot injuries and congenital deformities. People with flat feet or low arches are more prone to developing bunions, as are arthritic patients and ballet dancers. Whatever the initial cause, the problem seems to be exacerbated in Western cultures—where the percentage of bunion occurrence is higher—by ill-fitting shoes. More women than men are diagnosed with the condition, which leads doctors to believe that women’s high-heeled, narrow-toed shoes put excess strain on the toe joints and the toe bed, hastening any genetic tendency to form bunions.

WHAT ARE THE SYMPTOMS?
Usually the most noticeable symptom is the drifting of the big toe inward and the corresponding formation of the bump on the inside of the foot. Some people experience pain only when wearing tight-fitting shoes. For others, the bunion can become inflamed, swollen, and red, creating pain on contact. Corns and other irritations can form by the overlap of the first and second toes, arthritis can occur in the affected joints, and toes can bend upward to form hammertoes.

WHAT ARE THE TREATMENTS?
Since bunions are a progressive condition, it’s best to see a foot surgeon before the bunion gets too painful or severe. Early treatment usually includes wearing softer, more comfortable shoes with a wider toe box, avoiding high-heels, employing pads and cushions to reduce pressure on the bone, and using foot orthotics to reduce the tendency for the condition to get worse. Overthe- counter pain relievers like Tylenol and Motrin can be used for occasional pain, but should not be taken on a routine basis because of the risk of stomach and kidney complications. Cortisone injections may also be used to help alleviate joint pain, and physical therapy may be prescribed to reduce pain and inflammation.
If you find that your bunion is significantly slowing you down—you don’t go shopping or play golf anymore because of the pain—surgery may be an option for you. There are a variety of surgical options, and your foot surgeon will recommend which one is best based on your condition. Just scraping the bunion away doesn’t help much, as the bunion will often come back and sometimes progress more quickly. Surgeons will usually combine scraping with a correction of the bone itself. Through a variety of methods, they will realign the bone to a straighter position. Sometimes screws are hidden inside to keep the bone in place and speed up bone healing. (Some patients ask about laser surgery, but it is ineffective on bunions.)
Recovery time from surgery can be anywhere from 4-8 weeks. However, the days of wasting away in bed are gone, as inactivity only stiffens joints and delays healing. After today’s surgeries, patients are usually up and walking around the next day, though they may use crutches and a special post-operative shoe. Most patients are pleased with the results— particularly in mobility and pain relief—but will still need to remain cautious in choosing comfortable shoes.

Dr. Shazia AMAR
35 Ocean Pkwy.,
Brooklyn, NY 11218
(718) 853-5560
702 8th Ave.,
Brooklyn, NY 11215
(718) 840-0660
5205-7 Church Ave.,
Brooklyn, NY 11203
(718) 688-8000
Ave J
Brooklyn, NY
(718) 677-1710
DrSAmarDPM@yahoo.com