Bunions, also known as hallux valgus, are estimated to affect about one out of three people over the age of 65, but can be present from adolescence. They are one of the most common foot deformities and are more likely to affect women than men.
You may hear the most common complaints: they are unsightly and make it hard to wear certain shoes. However, while some people experience only mild symptoms of bunions, many people have progressive bunions that can begin to affect their activities and function.
What Are Bunions?
Bunions occur in what is called the first metatarsophalangeal joint, the large joint at the big toe. That metatarsal bone gradually shifts out from under the big toe, away from the other metatarsals, and the big toe angles toward the second toe. As a result, the foot widens and the base of the big toe bulges out.
Symptoms include pain, numbness in the big toe, hardening of skin on the sole of the foot, corns and a loss of joint movement.
The big toe can push on the second toe and destabilize it, causing hammertoes or claw toes, which in turn cause pain in the ball of the foot and a sense of “walking on a rock.” For some patients, there is an increased likelihood of osteoarthritis in the big toe joint, which can cause chronic and mobility-limiting pain.
Genetics and arthritis are major causes of bunions. Tight shoes do not always cause bunions, but they do contribute to their development and can exacerbate the pain.
I typically counsel my patients to be careful about their choice of shoes and to opt for supportive shoes when they expect to be standing or active for extended periods of time.
The toll that bunions can take on a patient’s quality of life forces them to miss out on activities they love or even have trouble walking, so it is strongly encouraged for anyone suffering painful or worsening bunions to seek help from an orthopedic physician.
There are several non-surgical treatment options for bunions, including shoe modifications, foot care and medications. Surgery should be considered if these treatments fail and if your bunion is negatively affecting your quality of life by causing significant pain or limiting your ability to stay active, despite modifying your shoes.
Surgery may not be the best option in cases where the patient has other medical conditions, such as severe vascular disease, or when no conservative measures have been attempted. As always, you’re advised to speak with an orthopedic physician to determine the best treatment for you.
The aim of bunion surgery (bunionectomy) is to restore the normal function of the foot and relieve pain by removing the protuberance and realigning the big toe joint.
Traditional bunion surgeries have a recovery time of up to eight weeks or more, but expect certain limitations post-operation: you may still not fit into tight shoes and your foot may not be fully restored to its pre-operative mobility.
Newer surgical options address some of the challenges of traditional surgeries. For example, PROstep minimally invasive surgery reduces soft tissue disruption and leaves smaller scars by using precise incisions.
This reduces further complications, the likelihood of adverse events, post-operative pain and swelling, and can allow for an earlier return to function than traditional surgery.
Restoring patients’ feet to their natural form makes a significant impact on their lives, and allows them to stay active for a well-rounded, healthy lifestyle.
What To Do
Whatever route your orthopedic surgeon recommends, if your bunions are limiting your ability to be active, and causing daily pain despite shoe wear modification, there is a path toward a pain free, functional foot.
The sooner you seek treatment, conservative or operative, the more likely you are to get relief and reduce the likelihood of your bunions worsening and affecting your ability to exercise and be functional.
Natalie S. Mesnier, MD is a Foot and Ankle Reconstruction orthopaedic surgeon. Visit pdxfootandankle.com for more info.