Q: Bunions run in my family, and I’ve got them bad — and they’re painful. During the summer I can wear sandals that don’t put pressure on my bunions. But during the winter and other seasons, every shoe seems to hurt. What can I do about my bunions?
A: I’m afraid I’m starting to sound like a broken record when it comes to the potential hazards of wearing high-heeled shoes, but I’d like to point out yet another reason to steer clear of them: bunions. Yet I’ll be quick to add that high heels—or any shoes, really—are not the actual cause of bunions, but they can certainly accelerate their growth if your foot type is prone to develop them.
What Exactly Is a Bunion?
It’s a bony bump on the joint at the base of the foot’s big toe. It forms when the bone or tissue of the joint is displaced, and the big toe is forced to angle towards the second toe, or sometimes even lie above or below it. This joint (known as the metatarsophalangeal, or MTP joint) carries a lot of the body’s weight when walking. So if it’s forced out of alignment (by high-heeled shoes with pointed toes, for example), it becomes unstable and deformed — and painful. Bunions grow after years of pressure on the MTP joint.
While many people are aware that bunions run in families, they are not inherited. In fact, what you’ve inherited is simply they type of foot that is prone to develop bunions. So blame your parents for faulty foot mechanics, but don’t blame them for bunions. Faulty foot mechanics include conditions such as flat feet, low arches, and over-pronation (when the foot rolls inward) that all affect the way we walk and the way we exert pressure on our feet.
Who Gets Bunions?
Nine out of 10 bunion sufferers are women, and narrow, tight, pointed shoes that squish the toes together could be the reason for that. Foot injuries, neuromuscular disorders, congenital deformities, arthritis, and inflammatory joint disease are other culprits. And occupations that place great stress on the feet, such as ballet dancing, might also be a cause.
In addition to that painful bump, secondary sources of aggravation from bunions might include redness and swelling at or near the MTP joint, corns or other irritations between overlapping toes, and restricted or painful motion of the big toe.
If you’re feeling pain at the base of your big toe, a visit to a podiatrist is in order. You won’t be able to change the shape of your foot and your inherited foot type, but there are treatment options to relieve pressure on the bunion and slow the progression of the deformity.
Treatment Options for Bunions
My treatment options for bunions would include:
- a recommendation to wear shoes with a wide toe box and instep, soft soles, and pliable leather. For comfortable and stylish shoes that are sold in many sizes and widths, I recommend a brand called Munro American. Sandals with a good arch that don’t cramp your toes and feet are great in the summer.
- padding around the bunion and big toe to minimize pain and stress.
- anti-inflammatory drugs and perhaps a cortisone injection to ease the severe pain and inflammation caused by a bunion.
- physical therapy that includes ultrasound to treat the soft tissue surrounding the MTP joint.
- custom orthotics in your shoes to correct the mechanics of your stride. Orthotics can help reduce pain when walking and prevent the bunion deformity from getting worse.
- surgery to correct the position of the MTP joint and re-align the big toe is a last resort.
Adolescent Bunions
Some final words of advice: if you’ve got bunions and you’re a parent, there’s a likely chance you’ve passed your foot type onto your children. So pay extra attention to your child’s feet and encourage her/him to wear shoes that fit properly and don’t cramp or pinch the toes. Teenagers (especially girls 10 to 15) may develop a condition called adolescent bunions, also at the base of the big toe. A teen may have pain and trouble wearing shoes, just like an adult, but the joint causing the trouble may move normally. Wider shoes and other non-invasive treatments may help, but surgery is not recommended for teens as there is a good chance the bunion will return. Come and see me if your teen has foot pain.
—Dr. Shier