A bunion, also referred to as hallux valgus, looks like a bump on the side of the big toe, but it’s really a structural change in the front part of the foot. According to the American College of Foot and Ankle Surgeons (ACFAS), a bunion occurs when the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment—producing the bunion’s bump.
“A shifting position of bone creates a bunion. Often, it’s a loose or what surgeons refer to as a hypermobile joint in the midfoot that causes the metatarsal – one of the five long bones in the foot below the toes – to shift,” says Sean Grambart, D.P.M., FACFAS, assistant dean of academic affairs in DMU’s College of Podiatric Medicine and Surgery (CPMS) and a podiatric physician in the University’s Foot and Ankle Clinic.
What are bunions?
Genetics are the primary cause of bunions. Symptoms of a bunion can include pain or soreness, inflammation and redness, a burning sensation and possible numbness. Wearing tight-fighting or high-heeled shoes and standing on one’s feet for long periods of time can exacerbate the deformity and its symptoms, Dr. Grambart says.
Unfortunately, bunions are a progressive disorder that won’t go away on their own. So what should a person with a bunion do? A plethora of options exist, but the best first step is to consult a podiatric physician.
“Podiatric physicians can provide information and advice on what’s best for each patient,” Dr. Grambart says. “They can evaluate and confirm the pathology and help especially if you are experiencing pain or limitations on your desired physical activity or are having trouble finding shoes that fit.”
Surgery is the only way to eliminate a bunion, he adds, but that doesn’t mean it’s the best option.
“Taking the time to educate patients on all the treatment options is essential. I tell patients that if they are doing what they want to do physically, without restrictions, don’t have the procedure,” he says. “Surgery is not a quick fix. It typically takes four to six months for the patient, post-surgery, to feel comfortable and trust their foot.”
How to treat bunions without surgery
Nonsurgical treatment options won’t reverse a bunion, but they can help make it tolerable. ACFAS lists these conservative treatment options:
- Changes in shoe wear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels, which may aggravate the condition. “I don’t recommend specific shoe brands, but I do advise patients to go to a store that will take the time to find a comfortable shoe for them,” Dr. Grambart says. “When you walk out of the door, you should feel that you are supported and your shoes feel better than what you had been wearing.”
- Padding. Pads placed over the area of the bunion may help minimize pain. These can be obtained from a physician or purchased at a drug store.
- Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Topical anti-inflammatories, such as Voltaren Arthritis Pain Gel (diclofenac), now available over the counter, can ease pain as well, Dr. Grambart says.
- Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
- Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint) sometimes seen with bunions.
- Orthotic devices. In some cases, custom orthotic devices may be provided by a foot and ankle surgeon. “However, orthotics can be a little bit tricky,” Dr. Grambart says. “When you put an orthotic in your shoe, it can make the shoe tighter. I typically suggest it only if the patient has additional pathologies such as flat feet. Orthotics also can be expensive, especially if one’s health insurance doesn’t cover them.”
Surgery for bunions
A podiatric physician may suggest surgery to treat bunions, also referred to as a bunionectomy. There are many different surgical options based on a patient’s clinical and x-ray findings, age, activity level and other factors. Surgical approaches may include an osteotomy, the surgical cutting of the bone to realign or remove part of it, and arthrodesis, the fusion of bones to realign or stabilize them. After surgery, a person can expect a period of immobilization in a post-operative splint or boot, which may include some time non-weight-bearing. After about six to eight weeks of immobilization, if everything is healing well, then patients can start to transition into a shoe, but it will take some time getting used to having shoes on again.
A foot and ankle surgeon will recommend the best treatment for bunions based on each patient’s situation.
“The foot is a very complicated weight-bearing structure of multiple bones and joints, and its function is critical to a person’s function and quality of life,” Dr. Grambart says. “That’s why it’s important, when you have a bunion that is causing you problems, that you see an expert on the foot and ankle – a podiatric physician.”