DEAR DOCTOR K:
I have a painful bunion. What is the best way to treat it?
A bunion occurs when two bones in your foot no longer line up properly. Normally, a bone in the foot lines up straight with the first bone in your big toe. With a bunion, the joint where those two bones meet no longer is straight.
Instead, there’s knobby bone bulging outward at the base of your big toe. And the big toe itself turns inward, bending toward, or even under, the other toes. As a result, the knobby bone at the base of your big toe points outward.
Bunions are a common cause of painful toes. One cause of bunions is thought to be years of wearing shoes that squeeze the toes into pointed or narrow toe boxes, forcing the toes to fold over one another. Since women wear such shoes, and since bunions are more common in women than men, that seems reasonable.
On the other hand, plenty of my female patients wear shoes that should torture their toes — but they don’t all get bunions. And some of my male patients have bunions. There’s also pretty good evidence that bunions run in families. So I doubt we really know all the causes of bunions.
Over time, a bunion can become extremely painful. You can relieve the pain by padding the bunion with felt, moleskin or a doughnut-shaped pad. Hot and cold compresses may help. Or try stretching the bunion area of your shoe with a shoe stretcher. Orthotic shoe inserts can redistribute your weight so the bunion doesn’t constantly rub against your shoe.
NSAID pain relievers such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can also help relieve pain and inflammation.
If these steps don’t work, surgery can restore your toe to its normal position. The surgery is a safe procedure, but you can’t walk on the foot for several weeks, so your mobility is affected. You need crutches or other devices to walk, and using stairs is tricky. While surgery doesn’t always relieve all the symptoms, patients are generally happy with the result.
If you decide to undergo surgery, the specific procedure will depend on the severity of your condition. To treat a mild bunion, for example, the surgeon might shave the enlarged portion of the bone before realigning nearby muscles, tendons and ligaments.
To correct severe bunions, the surgeon must cut and then realign a portion of the displaced bone in the toe. Pins, screws or plates will keep the bone in position. At the end of this post I’ve put an illustration of the toe before and after this procedure.
To prevent bunions from developing, or to prevent an existing bunion from getting worse, wear shoes with roomy toe boxes. While shoes may not be the sole cause of bunions, they can aggravate the condition. Look for shoes with blunt toes rather than pointed ones. And allow for a quarter-inch to a half-inch of space between your longest toe and the front of the shoe.
Surgical correction of a bunion:
The procedure illustrated above, known as a proximal osteotomy, is used to correct a severe bunion. First, the surgeon cuts away a portion of the bunion at the head of the metatarsal bone. Next, he or she removes a pie-shaped segment from the lower portion of the same bone, allowing for realignment of the metatarsophalangeal joint. Two pins or screws fasten the bone segments.