Bunions
The word bunion describes all or one of three different foot conditions. A soft swelling over the big toe joint – called a bursa. Enlargement of the bones over the big toe joint – is a bunion. Displacement of the big toe towards the other toes – is hallux valgus or hallux abducto valgus.
These conditions occur separately or together and involve complex stretching, straining and realignment of the bones, muscles, tendons and soft tissues that form the first metatarso-phalangeal joint, in other words, the articulation point between the big toe and the rest of the foot. However, no matter what we call the condition a bunion can be both painful and unsightly!
Because women frequently develop bunions, they are often regarded as a consequence of wearing high-heeled fashion shoes, but men also develop bunions. Whilst there is no doubt that poorly-fitting shoes contribute to the formation of bunions, the primary cause is the basic skeletal structure of the individual foot and that structure is dictated by our genes, we inherit it. There are always exceptions and rheumatoid arthritis is a common cause of bunions.
If we look at the anatomy of the foot joints where bunions develop, we see that the big toe joint is rather exposed. Since it does not have the muscles and tendons attached around it to provide strength – like the knee or elbow – the muscles on the inside of the joint easily weaken.
The stresses placed upon the joint during walking and exercise, cause the tissues to stretch and deform and if this is aggravated by an anomaly in the basic alignment of the bones, then bunions develop. They are painful and often accompanied by corns, callouses, tender nails and aching, burning feet.
So here you are with your bunions; you exercise regularly; your feet look funny – just like your mother’s. You have difficulty finding shoes. What options do you have?
The first question to ask is do they hurt? If you are in pain and your ability to walk comfortably is affected, see a podiatrist to have a biomechanical assessment and gait analysis. You may need shoe advice, treatment for painful corns and calluses, or possibly an insole or orthosis (a shaped platform inserted in your shoes) to improve the function of the joint. Finally, as a last resort, you may need referral to an orthopaedic surgeon.
The orthopaedic surgeon may or may not suggest an operation and they always want to know how much pain you are suffering. There are many variations of operation but only a small number are commonly performed, however they all require that bones, tendons and soft tissue have to be cut, removed or relocated.
This is why caution must be exercised before you agree to undergo bunion surgery. In addition, see a surgeon who specializes in the feet. At its simplest, only a small portion of bone may need chipping away (a bunionectomy), whilst complicated operations involve removing and realigning bone and relocating tendons.
If you have already had an operation, you may need exercise advice for your feet, treatment for lesions or pains (metatarsalgia) and advice on shoe selection, to prevent any regression and keep things well aligned.
For the operation to be successful, your co-operation is needed, together with you developing an understanding of what is going on inside your feet. This starts by doing exactly what the surgeon instructs you to do, or not do during your post – operative recovery period.
You may have to use orthotics in your shoes; wear toe-splints at night; and definitely fit your shoes correctly. Go for a wider shoe or have your existing ones stretched.
Can anything be done to prevent bunions?
Look at your feet and see where the callous forms. If you have a wide forefoot, callous on the bottom of your big toe, soft swelling over the inside of the ball of the foot and a foot that is beginning to look like a tennis racquet – now is the time to take action.
Visit your podiatrist and ask for a biomechanical examination. Consider buying a proprietary bunion splint to wear when you are not wearing shoes or to use in bed.
Exercises you can do at home can help
- Sit in a chair and place both feet on the ground side by side a few centimeters apart. Now try to move your big toes towards one another whilst keeping your feet still. You should feel a pulling sensation on the inside of the arch as the toe moves.
- Place a towel on the floor with your toes just on the edge. Using only your toes and keeping your foot flat, claw up the towel.
- Put a thin book on the floor & place your toes on the edge of the book, keeping your foot flat. Grip the book and make knuckles with your toes
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Comments on Bunions
Hi maybe some one can assist me.
I am a 21 year old. On my right side i have a bunion, and it is realy realy sore. i must make a dessision to go for a opperation but are scared for the outcome. As the days go by my foot is getting worse. I have been putting on gels and ointments to take away the pain but no can do. Does any body else have any other suggestions for me.
Hi Mariolanda. Painful bunions usually do require surgery to correct them. You are young , so the operation should be successful. However, make sure that you ask the surgeon all the questions that come to mind. Also get a clear explanation of what is required of you in the post-operative period. How long will you be off work? What will you have to do or not be able or allowed to do. In my experience most of the "unsuccessful" surgery is due to not being able to do what the surgeon expects of you. e.g. rest for 6 weeks and rest! Finally ask how much movement will be left in the joint so that you are not going to have to wear trainers with your cocktail dresses.
If you arestill unsure make an appointment with a podiatrist for a biomechanical assessment to see if some temporary orthotic care might help.
Hi there
I have a similar problem to Mariolanda. I am 24 years old. I have only recently had this bunion spring up! Its not painful yet but is permanently bruised. Its luckily not all that painful yet though! I am trying to weigh up my options to decide whether to have surgery or not. Suggestions?
Hi. My 7 yr old's big toes are very skew.i would like to know where do i go for help.
Hi Shereen,
my daughter Shoneez age 12 has a bunion on left foot and her big toe is skew. I have been advised to contact the foot foundation at Fourways Hospital on 011 875 1780. They have a website http://www.footfoundation.co.za I am trying not to let my daughter have surgery on her foot, good luck…
Chantal.
HiDoctor
I have bunions of both my feet. I hate it coz it is very painfull and ugly. Will the splint help to take it away or will i have to undergo surgery, if so can you refer me to a good surgeon please, and alos let me know where i can get the slpints from.
Kiind regards
Shanaaz (Cape Town)
Shanaaz
Start with the night splints. Also go and see a podiatrist who does biomechanical assessment.
I don't know how old you are, so it may be possible to try orthotic therapy before considering surgery, because if you are younger, there is a better chance of some re-alignment or correction. Look for a podiatrist in Yellow Pages or on the South African Podiatry Association websiteup http://www.podiatrist.co.za The splints are usually available from an Orthotist/Prosthetist or via your podiatrist.
Andrew
Hi, I am 22 years old and have bunions on both of my feet. It is painfull but not always, they are always red, and I cannot find shoes that is wider the help with the discomfert. I want to know what methods i can use to try and make it smaller perhaps. Someone did suggest surgery, but i am very scared of doctors so would prefer not going. My grandmother had them, and i remeber how she used to force her feet into shoes…
Please do any one have advice that actually works…
Thanks
Jackie
I have a bunion on my right foot & it was never a problem. About 2 weeks ago, my daughter closed the inside screen door (which leads to our porch) & I didn't realize it & went thru the door. My bunion hit the steel frame & has been sore ever since. No bruising & minor swelling occured. I have noticed that it has been sore to walk on this foot, though when I take some Advil/Motrin it's bearable. Any suggestions?
Barbara, I would have an X-ray to see if there is any damage to the bones. Try applying ice packs and Arnica oil or take Arnica tablets. Definitely take something for the pain, whatever works for you. At worst you may have a fracture or chipped bone, at best there is an inflammatory reaction in the bone and joint to the injury.
Jackie. Go and see a podiatrist and get advice and assessed for the structure of your feet. (Biomechanical Examination). You will have read elsewhere that I think surgery should be the last resort when you have addressed all other aspects that can cause bunions.
Surgery is the only permanent way to make them smaller. Depending on the amount of movement and the degree of deformity, there are night-splints that we prescribe to try to pull the bones straighter – they do work on some feet.
Although there is no significant evidence to back it up, many podiatrists try orthotics in your shoes in an attempt to delay the worsening deformity.
Hi Doc
I am 31 years old, and this is very painful at times.
Shanaaz
I really think you should go and see a podiatrist. Get some professional advice and help from someone who can see the bunions and do the examinations that I suggested.
Andrew
@Andrew Clarke:
I too have one on my right foot. I been to dr Saragas and surgery needs to be done.
Are there side effects? Will this affect my walking. wearing certian shoes. Can I wear high heels from time to time? Does this surgery cut the muscle? I was informed that theraph is needed for 4 months and a special shoe needs to be worn. Please advise/ I do not want to under surgery if this will have a side effect? I am 31 yrs old.Will this correct the big toe pointing inwards? He did say that a piece of the enlarged joint needs to be cut.
Sonja
There can be side-effects of foot surgery, they are in my opinion, usually more associated with the patient rather than the surgeon. I think it is very difficult for the patient to comply with the surgeon's expectations of rest, icing, probable changes in shoe type, alterations in joint alignment etc.
Th direct answer to your questions depends largely on which operation the surgeon does. Yor walking should remain basically the same. High heeled shoes may be a problem, but that depends on how much movement remains in the big toe joint. Again, depending on the type of operation, muscles may be repositioned, to ceate a better'line of pull'. Thorough rehabilitation takes a long time and requires a special post-operative boot/device.
As you are so concerned, perhaps a visit to a podiatrist OR a second opinion from another specialist foot surgeon would be a good idea, especially as you do need to understand the biomechanics of your feet.
Andrew
@Sonja: Dear Sonja. I had the operation done in November last year. You will see my comment above in October last year just before I consulted an orthopaedic surgeon and was told I had to have the operation. I had to have a pin and staple placed in my toe.
Anyways, the healing process is long, well it was for me. The doctor told me to keep off my foot for the first 2 weeks after the op and you have to. After that I started walking around with crutches and by week 5 I was walking without crutches (still in the cast though). The cast came off after 6 weeks – what a horrid sight!!!! And it took a while to get used to walking again. For the first month at least all I could wear were these slops that velcro over your width of your foot. Oh and crocs – thank goodness for crocs – get yourself a pair. I have one in every colour almost now. It took a while before I could get into closed shoes and I still battle sometimes. I did have to get rid of a lot of my shoes – I cant handle anything that squashes my toes at all now. And I still havent worn high heels since and its been almost a year! Not planning on it anytime soon either.
My big toe now points in the right direction and the scar is healing up nicely.
I wish you lots of luck though!!!
Tarryn – you sound like the perfect patient. Thanks for your honest input. I always think the patient has the hard time. The surgeon just cuts you up and goes home!!!
It is a long process – have you had much pain? You must protect your investment now with appropriate shoes. I see Crocs do have some benefits after all. Did you also buy some of their furry winter boots? Here's to complete healing, straight toes and no pain.
Hi there, thanks for the motviation.
I cant say its been an easy process. At the moment I am still battling with the spot in my foot where the doctor put the pin in to straighten – its super sensitive and thats why I am still battling with the shoes I wear but the rest has healed up pretty well.
Cant say I have seen the crocs boots – will have to keep an eye out for those!!
Thanks again for the advise provided, it definitely helped me!
Hi Taryn
Do they remove the pin and staple>. Does your toe hurt when the weather is cold?I am bit worried only having to wear flat shoes\as I work in a corporate environment, always wearing high heals.
Dear Sonja
They dont remove the pin and staple – I am afraid we get stuck with that. Mine doesn't hurt at all from the weather though. The problem is the area around the cut is super sensitive. So it makes it really difficult to wear heels especially if its a closed shoe. I am a year down since the operation and I really still have to watch what shoes I wear – I gave more than half of my shoes away because I am pretty certain I wont get back into them anythime soon! Personally, I didnt wear high heels much anyways but even the thought of trying to get into them now freaks me out. I am stuck on flat slip ons, sandals, slips slops, sneakers and any other shoe I can fin thats not to tight on the side of my foot.
Its a difficult process, I wont lie. Just the healing process – to be able to walk properly again took at least 8 weeks and thereafter I was mostly in slippers and slops for quite some time.
The operation is necessary though, if you dont have it your big toe will land up moving your other toes out the way and then they will also have to be operated on in time, thats what happened to me. Luckily I caught it in time so they only had to operate on my big toe and second toe – if I had waited longer it would have been my third toe as well. Dont postpone, seriously, just get it over and done with. My advice – good painkillers for after the operation, a loving family member to take care of you as much as they can (even something so stupid as carrying some juice and going to sit down is not possible with the damn crutches), and an abundance of movies to keep you busy while on the couch resting it out!
Good luck and shout if you want any more advice.
Hi Sonja
Tell me something is your Big toe straight now, because my toes are very skew and i hate it. It hurt so bad sometimes that i don't want to walk. Could you also give me contact details of the doctor who's done your op.
Kind regards
Shanaaz
Hi there
I saw this article on non-invasive bunion surgery by a German doctor practising in the UK. Apparently you can walk after the surgery and it is not too painful. Do we have something like this in South Africa.
http://www.dailymail.co.uk/health/article-1051558/Pain-free-surgery-cured-bunions-just-minutes.html
Hi there.. I want to find out, I am 17 years old and my index toes on both feet are going skew and our pointing towards my baby toes.. Please help!
Hi, im wondering if anyone can help.
I am from england and am 14 years old
i have been suffering from extreme pain caused by bunions for over a year now
i visited the pediatrician and she gave me these insoles and my doc gave me ibuprofen.
but they are both ineffective, and am still in as much pain. well. more really.
what can i do, and what can my pediatrician do for me?
oh, and does surgery help because missing out on pe lessons because im in agony is starting to get a bit boring. so is being kept awake at night by the pain :/
Hi
I have bunions and so did my mother. My 24 year old daughters have them as well. The one is wanting to do triathlons but has always suffered from pain inside her foot towards the front of the foot. Are the bunions causing this? What is the non avasive bunion surgery?
Hi doc
i am 20 years old, and i've had a bunion type thing on my right foot since i was about 15. It is usually quite red and inflamed, my foot are very prone to blister etc anyway and seem to be getting progressively worse. It is getting to the stage I have to wear trainers to walk ANYWHERE, i have to wear them n change into my smarter shoes for work etc, it's such a pain, especially as my feet still blister and my bunion still gets really sore even wearing other shoes for the short time i do.
i walk everywhere though and couldn't afford 6 weeks off off uni.. who knows.
Any advice?
Hi Emily,
Sounds like you need to have someone look at 'the thing,' so that a diagnosis can be made. Perhaps you have very flexible feet and they could benefit from some form of correction – not a euphemism for surgery!
Whenever you get blisters, it means there is some friction and it is often caused by excessive movement in the shoes, so improving alignment might help.
One direct practical thing to try is to cover 'thing' with an adhesive dressing, some Pharmacies sell something called Blister protection.
Why not make an appointment with a podiatrist?
Regards
Andrew
Hello Liz,
Sounds like a set of 'bunion genes' in the family! Your daughter's foot pain could be coming from her bunions and that is why a detailed Biomechanical assessment and Gait analysis is essential before she gets really into Triathlons.
There might be a simple solution to her problem. Get her to see a podiatrist who can do the proper examinations and make informed recommendations.
Non-invasive surgery is really a misnomer, there are manipulation techniques that some practitioners perform, to try to limit the deformity. I don't have experience of it and don't know any podiatrists in SA who practice it.
Regards
Andrew
Hello Jessica,
This is no good at all. Did you see a podiatrist or a paediatrician? You really MUST see a podiatrist and if you are in the UK find out from your Local Authority or the Society of Chiropodists and Podiatrists where you can find a Podiatric Foot Surgeon. Look at the website: http://www.feetforlife.org
In addition, if the insole are hurting go back and complain!
As you are young, you must get a Biomechanical assessment done to find out if there is anything wrong with the structure and function of your feet. Do you live near to a University where Podiatry is offered as a degree? you might be able to go to their clinic for assessmnet and advice.
Surgery might help, especially if your feet are flat, but finally you should be looked at to make sure that the foot pains aren't associated with something else like Arthritis.
Hope this helps. Get back to me if you want more info.
Good luck
Andrew
Hi Steve,
Get yourself along to your nearest podiatrist for a Biomechanical Assessment and Gait Analysis. There are so many causes for your toes moving across that you need someone to look and see.
You can start by looking at your shoes to see if they are leaning in along the arches of your feet – that might tell you whether they are tending to be a bit flat.
A good podiatrist will be able to assess your standing, walking and footwear, make a diagnosis and recommend treatment.
Find a podiatrist on the SA Podiatry Association website: http://www.podiatrist.co.za
Regards
Andrew
Hi There
I am 28 years old and suffer from Bunions. It is only on my right foot and not painfull at all. Where can i get these night splints. I am from the Randburg JHB area.
Hello Shaakira
Contact any Orthotist/Prosthetist. You should be able to get a local address from Sandton Clinic or phone our rooms: 011 726 6363 and ask Lauretta to give you some names.
Andrew