Bunions can affect your quality of life

Bunions, when bad enough, can keep you from enjoying just about everything you do on your feet. And they are quite common.

According to a meta-analysis published by the National Institutes of Health, bunions occur in 23 percent of adults ages 18 to 65, and 37 percent in people over the age of 65. They are much more prevalent in women than men.

They can range from barely noticeable to very painful, according to orthopedic surgeon Natalie Nielsen, MD, at Falmouth Orthopedic Center.

“There’s really a big spectrum of bunions,” she said. “Sometimes the deformity is mild, where the great toe is turning towards the lesser toes, resulting in a bump on the side of the foot. Often these aren’t too painful and it is reasonable just to keep an eye on them. Using wide toe box shoes and a toe spacer are helpful from preventing the deformity from worsening.”

Other times, bunions are more severe and can cause the big toe to push on the second toe which may result in a hammer toe deformity, she said. As a bunion becomes more severe, it can cause your other toes to drift out of position. Even though it’s rare and only happens when a person has had an untreated bunion for many years, a severe bunion can cause the toes to dislocate.

“Usually when that starts to happen, the foot becomes progressively more painful, as the rest of the toes become involved, Dr. Nielsen said. “The other thing that can happen with time is you can start to get arthritis from the malalignment of the toe joints. If the arthritis is starting to become more significant, the pain often gets worse.”

Causes and Treatment

Bunions can develop after wearing high heels or pointy shoes. Dr. Nielsen saw many such cases that were caused by footwear when she did her fellowship in New York City.

However, there is not always a clear cause. “There is a genetic component to them, so you could wear good shoes your whole life and still get a bunion,” she said.

Most of the time, there is not a rush to fix a bunion unless it becomes painful or the deformity becomes severe. There are gel toe spacers people can use to keep the bunion from getting worse. For people who have pain from bunions in the ball of their foot, they can buy metatarsal pads to cushion and support the area.

There are a variety of over-the-counter bunion products, but Dr. Nielsen said that most of them do not work.

“The only way to really straighten out the toes, once you have a bunion, is with surgery,” she said. “There are a variety of ways to fix them. Much of it depends on how severe your deformity is and if there is already arthritis involved or not.”

Often, the procedure involves cutting the bones and realigning them, which allows straightening of the big toe while retaining motion of the joints, she said.

“Once you straighten out the toes and you get rid of any of the bony prominences, it helps people to walk better. It’s definitely effective for pain control. There are fusion-type surgeries that can be done if there is a lot of arthritis, and those are also very successful for alleviating pain.”

Some people prefer to wait and see whether a bunion gets worse over time. It might be a little uncomfortable but not terribly painful.

“If people have questions, they are welcome to make an appointment to discuss what the options are and if there is even a need for surgery. In general, there is not a rush to have a bunion fixed surgically, and there are nonoperative treatments that can be helpful in alleviating pain.” Dr. Nielsen said.

Recovery

The surgery is day surgery and recovery time depends on how severe the bunion is. With mild to moderate bunions, patients can walk on the treated area afterwards. For more severe cases, patients would have to be non-weight-bearing for four to six weeks, depending on what is done in surgery. The patient would wear a splint while the stitches heal, and then move on to wearing a boot.

“A lot of people use a knee scooter if there is a need to be non-weightbearing, so you can be up and around and go back to work, as long as you don’t have a job where you have to stand all day long,” Dr. Nielsen said.

Bunions can come back after surgery, but it is extremely rare. The need for more than one surgery for a bunion is very uncommon, she said. Surgery is a safe and effective procedure for those patients with symptomatic bunions who have not had success with nonoperative treatment.