Do Bunions Need Surgical Procedures?

Overview
If you?ve developed a solid bump at the base of your big toe along with pain and swelling, it?s possible that you have a bunion. According to the American Podiatric Medical Association (APMA) A bunion is an enlargement of the joint at the base of the big toe-the metatarsophalangeal (MTP) joint, that forms when the bone or tissue at the big toe joint moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the body?s weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. Bunions, from the Latin ?bunio,? meaning enlargement, can also occur on the outside of the foot along the little toe, where it is called a ?bunionette? or ?tailor?s bunion.?

Causes
The underlying cause is a deformity of the joint at the base of the big toe. The deformity is called hallux valgus. In this deformity the joint develops a prominent sideways angle. Due to this deformity the bones of the big toe are pushed towards the smaller toes. The skin over the angled joint then tends to rub on the inside of shoes. This may cause thickening and inflammation of the overlying skin and tissues next to the affected joint. In most cases it is not clear why a hallux valgus deformity develops. There may be some hereditary (genetic) tendency to have a weakness of this joint. In some cases it is associated with a joint problem such as osteoarthritis or rheumatoid arthritis. However, whatever the underlying cause, wearing tight or badly fitting shoes tends to make the problem worse. Wearing such shoes puts extra pressure on the big toe joint and causes friction on the overlying skin.

Symptoms
Patients with bunions will often display pain over the prominent bump on the inside of their forefoot (the medial eminence?). However, they may also have pain under the ball of the foot (under the area near the base of the second toe). Symptoms can vary in severity from none at all to severe discomfort aggravated by standing and walking. There is no direct correlation between the size of the bunion and the patient?s symptoms. Some patients with severe bunion deformities have minimal symptoms, while patients with mild bunion deformities may have significant symptoms. Symptoms are often exacerbated by restrictive shoe wear, particularly shoes with a narrow toe box or an uncomfortable, stiff, restraining upper.

Diagnosis
People with bunions may be concerned about the changing appearance of their feet, but it is usually the pain caused by the condition that leads them to consult their doctor. The doctor will evaluate any symptoms experienced and examine the affected foot for joint enlargement, tissue swelling and/or tenderness. They will also assess any risk factors for the condition and will ask about family history. An x-ray of the foot is usually recommended so that the alignment of big toe joint can be assessed. This would also allow any other conditions that may be affecting the joint, such as arthritis, to be seen.

Non Surgical Treatment
Wear comfortable shoes that don't squeeze your toes together. Sandals are ideal in warm weather. Cushioning the bunion with a donut-shaped bunion pad sold at drugstores can prevent any direct rubbing against your shoes. Have your shoes stretched to give your foot more room or consider switching to footwear customized to relieve pressure on the affected area. Soak your foot in warm water to help lessen the pain after a day on your feet. Apply ice packs several times a day to reduce swelling of painful and inflamed bunions. Take aspirin or ibuprofen for the inflammation and pain, and try supplementing with anti-inflammatory herbs such as ginger and turmeric (these work more slowly than the drugs). See a podiatrist for specially fitted shoes or orthotic devices that may help. Sometimes, surgery is necessary. Seek a second opinion before scheduling any operation.

Surgical Treatment
Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

Prevention
If you are genetically at risk, not a lot. But shoes that are too narrow, too tight (even ballet flats) or have very high heels that force your toes down into the pointed end are asking for trouble. Aim for a 1cm gap between your toes and the end of your shoes. This doesn?t mean wearing frumpy flatties, the Society of Podiatrists and Chiropodists recommends sticking to 4cm heels for everyday wear, and wearing different types of shoe to vary the position of your foot. Gladiator styles can help because the straps stop your foot pushing down into the point of the shoe, ditto Mary Janes (sorry but for beautiful feet they need to have a strap), and flat, wide-fitting brogues are a no-brainer. Alternatively, in summer you can wear flip-flops to keep the space between your big and second toe as wide as possible. If you have children it?s vital to make sure that their feet are measured for properly fitting shoes to nip any potential problems in the bud. Keeping your feet and lower legs supple and strong is important too, that?s how A-list celebs get away with wearing killer heels, they all work-out like crazy. Exercises like trying to widen the space between your big toe and the second one with your foot flat on the floor, a few times a day can help, as can calf stretches. If you are devoted to any exercise that involves high impact for your feet, it might be worth checking that your gait and shoes are correct with a specialist shop such as Runners Need, as poor styles can cause irreparable bunion-related problems that will consign your trainers to the back of the cupboard for ever.