Bunions and Foot Pain

What Is A Bunion?

A bunion is a deformation of the bone and joint at the base of the big toe that is either caused by a swollen bursa sac and/or by the big toe angling inward. This angling of the toe causes the head of first metatarsal of the foot to become visible. The bones are then thrown out of alignment, thus causing a bunion, or visible ‘bump’ to form.

 

painful bunions

Bunions worsen progressively over time, and although they begin with the big toe leaning inwards, the angle of the bones in the foot gradually change to produce the characteristic bump, which then becomes increasingly large. When you have bunions and foot pain develops this is usually and indicator that the growth is in the later stages when the deformation has become quite severe. 

Who Is At Risk?


Although anyone can develop bunions studies have shown that women are 10 times more likely to suffer from this condition, most likely because of constrictive footwear and the wearing of high heels.

What Causes Bunions?


Aside from wearing restrictive, narrow shoes or shoes with a wedge or heel that push the toes forward into a cramped position, it has also been suggested that there are genetic factors at play that may make some people more susceptible to developing bunions than others, particularly in people who inherit unusually flexible joints.
More rarely, bunions can develop as a result of inflammatory diseases such as gout or rheumatoid arthritis.

Symptoms

Bunions do not always cause painful symptoms, and a person may only be aware that they have a bunion due to its visible presence on the side of the foot.

When symptoms do occur they usually involve discomfort when walking, applying pressure to ball of the foot, or when wearing even mildly constrictive foot wear. Bunions may often cause swelling, redness and tenderness in the soft tissue surrounding the affected joint.

Treatment

Bunions are usually only removed if they cause significant pain or if the bone deformation is severe, and when there are surgical and non-surgical options available most doctors will opt for non-surgical treatment first. Here is a breakdown of common treatments of both the non-surgical and surgical type.

Non-Surgical Treatments:
Your doctor or podiatrist will most likely suggest non-surgical treatments first, such as:

• Bunion pads
• Advising the use of orthotics such as insoles and toe spacers
• Changing your footwear
• Pain killers

Let’s take a look at these treatments in more detail:

Bunion Pads

Bunion pads are an easy, accessible, and affordable way to reduce pain from this particular deformation. Reusable adhesive gel or felt pads are readily found in pharmacies and regular department stores . The other option is to purchase a bunion sleeve that slips over the big toe. Both options serve the same purpose: to protect your foot from friction and pressure and to prevent the enlarged joint from rubbing against your shoe.

Orthotics

Orthotics refers to any device that is placed inside your shoes to help shape and align the bones in your feet, particularly when there are issues of deformity or discomfort. Toe spacers are particularly good at keeping toes in line and preventing deviations or overlaps, and they are usually high on the list of recommendations. Insoles cushion the foot and reduce pressure on bones and joints. Bunion Splints are a specially designed splint for the toe that uses straps and guards to keep the misaligned bones and joints in place.

Orthotics are easily found in pharmacies and regular department stores but depending on the severity and the nature of your bunions and foot pain your doctor may recommend having custom inserts designed by a podiatrist. Either way it’s crucial that your orthotic fits you properly, so it’s wise to seek a advice from your GP or specialist as they can suggest which products will be best suited to your needs.

Having custom orthotics means having inserts that are tailor made for both your feet and your lifestyle. Here are some of the factors that will be considered when ordering custom work:
• Material: Orthotics can be created with a variety of different materials such graphite, polypropylene, leather and cork. Your lifestyle and level of mobility will be the deciding factor in which material is used.
• Thickness: The thickness or your orthotics is decided by your weight, as it is the thickness level that provides comfort and stability when you are active.
• Post: An orthotic post is usually added to control abnormal foot position and movement and to stabilize the heel and mid-foot while walking or standing. It will also help distribute pressure evenly throughout the foot.
• Height and Width: Both of these elements can be customized to ensure that your orthotic conforms to the shape of your foot, which not only makes it more effective but also ensure maximum comfort.

Regardless of which type of orthotic is designed for you, your podiatrist will also provide you with custom liner to ensure that your insert fits comfortably and does not rub against your skin or cause discomfort of any kind.

Changing Your Foot Wear

Footwear is a common culprit when tracking down the cause of bunions. When treating bunions your doctor will question you on what type of shoe you generally wear and the frequency with which you are wear constrictive shoes and/or high heels. Wearing wide-toed shoes that fit well and give ample support to your arches will give your toes plenty of room and will decrease pressure on your bunions. Heels that exceed a height of two inches should not be worn.
Pain Killers

If you are experiencing intense discomfort from a bunion, painkillers such as ibuprofen or acetaminophen can help ease your pain, but using over the counter medication to simply dull the pain is not a long term solution. Be sure to follow all directions for use and it is highly recommended that you see a professional for long term care.

Surgical Treatments

Your doctor or podiatrist may turn to surgical options if your symptoms are severe and fail to respond positively to any of the non-surgical options presented above. While those options are designed to alleviate discomfort and prevent the symptoms from getting worse the only way to get rid of a bunion is to surgically remove it.
Bunion surgery is usually not performed for cosmetic reasons alone, and while up to 85% of surgeries are successful care must be taken because bunions can return after surgical intervention. The style of shoe you wear may be permanently limited due to the risks associated with restrictive or heeled footwear.
Several factors need to be evaluated when considering this type of surgery:
• Age
• General health
• Occupation and lifestyle
• Severity of affliction

While surgery of this type is not considered ‘major’ surgery the patient is carefully evaluated before going under the knife. Here is an expanded outline of the extenuating factors evaluated before surgical treatment for bunions will be granted:

Age

Age is a factor for bunion surgery not just because of the anesthesia involved but because young people run an increased risk of the bunion returning for several reasons, including the fact that they’re bones are still forming, they tend to be more active, and they also have a tendency to forgo sensible shoes for fashionable footwear. This generally means that unless the problem is debilitating non-surgical treatments should be put into place as best as possible until the patient is older.

General Health

Evaluating your general health is standard procedure for any kind of surgery; pre-existing medical conditions can prevent, or interfere with, the healing process. For instance, diabetes often affects the circulatory system, which increases the risk of infection and/or a delayed healing of wounds, both of which are serious problems for recovering surgery patients. It is imperative that all candidates fully disclose their medical histories and the state of their current health before proceeding with any type of surgery.

Occupation and lifestyle

Occupation matters a great deal when considering bunion surgery; if you are a professional dancer or athlete this type of treatment will likely not be a realistic option until retirement. Likewise, lifestyle is an important consideration as well; if you lead an active life that involves sports and physical activity joint mobility will likely be a priority for you (surgery may decrease range of motion in your toes) and an active lifestyle increases the chances of the bunion returning post-surgery as well. Bunion surgery may cause reduced mobility in the foot even if the rest of the healing goes well.

Severity of Affliction

Surgery for bunions is usually only an option if you are in serious pain and non-surgical remedies have failed to alleviate symptoms or prevent the problem from worsening. There are risks and complications with any surgery and bunion surgery is no exception. The decision on whether or not to undergo this invasive treatment will be made with your GP and/or podiatrist.

General Surgical Procedures

Regardless of the type of surgery that is decided upon a local or general anesthetic will be administered. A minimum of one incision will be made in the area of the big toe to allow surgical instruments to be inserted and manipulated, sometimes with the help of x-rays. Post-surgery requirements may include a plaster cast or other type of dressing to stabilize the toes and foot in the correct position, though you may be given a special shoe that allows you to walk by putting the pressure on your heel.

Types of surgery

There are several different types of surgical procedures used in the treatment of bunions, and it is the severity of bone deformation and displacement that will dictate the method used for each individual patient. The overall condition of the joint will be evaluated as well. Surgical treatment may involve the use of screws or pins to hold everything in place during the healing period, though some of these tools may be permanently left in the foot in certain cases. The following list outlines the most common types of surgery for this type of affliction:

Osteotomy
This is the most common surgery performed for bunion correction wherein the protruding lump is removed from the bone in the toe so that the foot structure can be correctly realigned. The toe joint will also be realigned, and this too may involve removing auxiliary pieces of bone that are not a part of the visible deformation.
Distal Soft Tissue Realignment
This type of surgery is most often used to treat a mild deformity of the bone. The bunion is minimized through soft tissue manipulations such as tendon release and capsular tightening. This type of treatment aims to improve the stability of the big toe joint specifically, and the foot in general. While this type of treatment can be performed on its own it’s usually used in tandem with an osteotomy.

Arthrodesis

Arthrodesis is usually only proscribed for bone deformities that are too severe to be fixed with other treatments as it requires fusing the two bones in your big toe joint together. Cases involving severe rheumatoid arthritis or radical deterioration are prime candidates for this type of surgery. Arthrodesis is not generally recommended for younger patients as the big toe will no longer move at the base (the metatarsophalangeal joint will become immobilized.)

Keller’s Arthroplasty

Keller’s Arthroplasty is also called an Excision Arthroplasty as it involves excising the bunion as well as part of the afflicted joint bone of the big toe. A ‘false joint’ forms along with the resulting scar tissue, which involves using temporary wires to pin the joint in place for roughly three weeks post-surgery, at which point the pins are removed.
This procedure is reserved for severe and difficult to treat bunions in very elderly patients.
Minimally Invasive Bunion Surgery

This is a very new type of surgery being explored by The National Institute for Health and Clinical Excellence (NICE), but as the procedure is very new there is little reliable information on the effectiveness—and the safety—of this procedure.

Post Surgery Care

After undergoing bunion surgery you can expect foot and ankle swelling to occur for three months, and sometimes longer. You will be required to keep your foot elevated in order to minimize swelling and you will require crutches when moving around. You will not be wearing your usual shoes for three to four months post-op; in fact, you may be required to wear special shoes that allow you to walk on your heel while protecting the incision. A plaster cast or other forms of bandages may be used to keep bone and soft tissue in place during the healing process as well.

Your doctor or podiatrist will also discuss modifying the type of shoe that you should wear. You will be encouraged to wear flat or low heeled, wide-fitting shoes with good arch support that are ideally made from leather in order to avoid constricting the pressure points of the feet and toes. Post surgery foot care is absolutely crucial to avoid another bunion, and foot pain, from developing once again.

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