ESCANABA — Another reader asks “My mother has really bad bunions. Her big toe is sitting on top of the other toes. It looks terrible and causes her pain. My bunion is really mild. Is surgery the only treatment?”

Dr. McLean responds: As recently discussed, bunions can lead to a variety of complaints, from a deformed second toe to low back pain. Certainly, bunions can cause pain over the bump on your foot, as is predictable. That is an essential component of this common deformity, a bony prominence at the base of the big toe. Shoes aren’t made to fit this bone ‘poking’ out of your foot.

This requires a discussion of anatomy and function, the latter better summarized in the term ‘biomechanics’. This describes how the body moves when in contact with the ground, far different than the motion when the leg is suspended in the air, hanging off an exam table. Because of the complexity of the musculoskeletal system, and the interconnectedness of the thousands of moving parts composing the human body, the study of bipedal biomechanics is an evolving specialty.

Some methods of dealing with a bunion are simply common sense, such as wearing wider shoes. Various types of padding are available although they tend to add bulk to the inside of a shoe. Numerous braces have been fashioned over the years, many promising to correct the deformity (although none have shown any ability to do so), and don’t work well inside a shoe.

When one or more family members are afflicted with this condition, prevention can and should be instituted early. Experts in the science of biomechanics will often prescribe and fit someone with a family history of bunions, or with early signs of development, a custom arch supportive device referred to as a foot orthotic. These can be designed to reduce those abnormal forces leading to the change in positioning and alignment of the first metatarsal.

Hallux valgus is more likely to occur with certain foot types. A common scenario is one in which the arch rolls down excessively (pronation). Preventing this extra motion of the arch will go a long way toward stopping or reducing the drift of the first metatarsal. How best to achieve this will depend on numerous factors. An accurate, detailed analysis of anatomy and biomechanics can provide this information, allowing the formulation of a plan for prevention.

For many of us, this toe malalignment is hastened by a tight heel cord, the infamous Achilles tendon. Put simply, this, the largest tendon in the body, puts more force on the front of the foot and therefore the first metatarsal. Stretching out this structure can benefit many other body parts, especially the knee and spine. But since this is an incredibly time consuming effort, many attempt this but never achieve measurable gains.

Over a hundred different surgical procedures have been used to correct hallux valgus over the years. Many of these are historical, yet a variety of techniques continue to be utilized. Much depends on the age of the individual, their symptoms, the specifics of the deformity, as well as their biomechanical function. The conclusion is that one size does not and should not fit all.

Not everyone needs to have a complete reconstruction, with cutting of the metatarsal bone and realignment of the head. For some, a simple bump removal is all that is required to resolve their complaints. One approach with a long history of success involves cutting (precisely) through the neck of the first metatarsal bone and shifting the head over, back into position. Different bone cuts have been performed, each with its own nuances and drawbacks. But various other components are typically involved in the constellation of procedures used to treat the deformity.

Bunion correction through small incisions, called minimally invasive surgery, has been performed for years but has experienced explosive growth over the last decade. Minimally invasive practices are used not just in bunion correction, but in numerous other surgeries and conditions. Smaller incisions generally mean less pain and better cosmetic results, along with less swelling or risk of infection. Typically, the recovery is easier as well.

An improved understanding of human gait will serve to better the lives of millions of Americans. Anything which changes normal biomechanics, and bunions are included in this list (since the altered anatomy changes how we walk), may lead to significant pain and disability. This is due to the repetitive nature of gait, the proverbial ten thousand steps a day, often resulting in all manner of lower extremity and spine problems.

In conclusion, don’t assume your bunion has no consequences other than some pressure to the bump. Similarly, it is an inaccurate conclusion to say that a major reconstructive procedure is the only approach, especially to a minimally active senior. Ask questions of your doctor, learn about the condition and what all your options are. More so today than ever before, be your own health advocate. Your health depends on it.

— — —

Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.