ESCANABA - A bunion is a bony hump that forms at the base of the big toe where it attaches to the foot. The base of the big toe pushes outward on the bone directly behind the big toe called the first metatarsal bone, and forms a bunion. If the hump happens on the little toe and fifth metatarsal, it's called a bunionette.
Because bunions occur at a joint, where the toe bends in normal walking, they can be extremely painful. At the very least, many people who have bunions are unhappy with their appearance.
Foot problems typically develop in early adulthood and get worse as the foot spreads with aging. For many people, bunions run in the family. They may also develop with arthritis or in individuals who have one leg that is longer than the other. Women are more likely than men to suffer from bunions, leading many physicians to believe the problem may be caused by narrow, tight-fitting shoes with pointy toes and high heels. More commonly, though, the underlying cause is believed to be an inherited foot type.
Bunions do not go away and often get worse over time. However, there are options for relief that may also prevent the bump from getting bigger.
One of the best things you can do if you notice a bunion forming is to be very careful about the shoes you wear. Make sure they have a large toe box with plenty of room for your toes. Even though you may be tempted by a soft, cushy feel, remember that your foot needs stability as well as shock absorption. Avoid heels higher than 2.25 inches; they tip the body's weight forward onto the metatarsal joints of the foot. You might also try orthotics - either custom ones designed to match the needs of your feet or less expensive over-the-counter inserts. If you have pain, you can ice the area and apply a non-medicated bunion pad to your foot. All of the above must be considered effective treatments since they can ease pain and delay or halt progression of deformity.
Surgery is an option ordinarily reserved for persons with severe pain that limits every day activity. To determine whether surgery will be beneficial and what kind of procedure is best for you, a podiatric surgeon will use x-rays and a physical examination to determine the extent of the misalignment and damage to soft tissues. For a mild deformity, the operation may involve shaving off the enlarged portion of the bone and then placing the muscles, tendons and ligaments back into better alignment. For severe bunions, the metatarsal bone must be cut at the base, rotated and fixed in place with pins or screws. Bunion surgery can be performed on an outpatient basis, sometimes with local anesthesia, but recovery is usually painful, long and frustrating.
As with any surgery, there are possible risks and complications, which your doctor will discuss with you. Even with surgery, a bunion may reoccur and a person will likely never be able to go back to wearing high heeled, pointy shoes. Bunion surgery is for persons with serious pain and disability and should not be considered for cosmetic or preventive reasons.
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EDITOR'S NOTE: Dr. Leveille is a board certified podiatrist on staff with OSF St. Francis Hospital & Medical Group. He sees patients at Great Lakes Podiatry in Escanaba.