Bunions: What they are and how they’re treated

This content is sponsored by MedStar Washington Hospital Center.

Anyone who has had bunions can attest to the pain they cause — it can radiate from the big toe, impact the whole foot and restrict movement. Yet, many people may unnecessarily suffer through the pain of bunions for years before seeking treatment.

MedStar Washington Hospital Center’s understanding of bunions, patients’ best treatment options and paths toward a pain-free life can help those who think they may be suffering from a bunion.

A bunion is a bony lump that develops on the base of the big toe with the big toe pushing against the second toe. There can be multiple reasons why a bunion forms, but for the average patient it is hereditary, said Dr. Ali Rahnama, a foot and ankle surgeon at MedStar Washington Hospital Center. He noted that while tight shoes and high heels can make symptoms worse, wearing them is not often what causes a bunion.

Bunions do not just impact older people either, Dr. Rahnama said.

“Bunions can become prominent and painful as early as the teen years,” he said.

Many of Dr. Rahnama’s patients know when they come to see him that they are suffering from a bunion, and “they want to know what to do about the pain and discomfort they are experiencing,” he said. The most common symptoms of bunions include pain at the base of the big toe joint that make it red, hot and swollen — especially after they have been in tight shoes. Also, bunions can cause the skin around the great toe joint to become thickened or swollen.

It’s important to see a doctor for bunion pain because it could be indicative of another issue, Dr. Rahnama said.

“A lot of times we see that a bunion comes hand-in-hand with a larger orthopedic or foot and ankle deformity, such as flat-footedness or tightness in the Achilles tendon,” he said.

There are some first-line treatment options that can help patients with the pain of a bunion. Those options include taking oral anti-inflammatory medications, or using shoe inserts or toe spacers.

“None of these things will actually get rid of the bunion, they may just help with simply alleviating the pain that the patient is experiencing,” Dr. Rahnama said. “The most definitive way to treat them is by surgically correcting them.”

Dr. Rahnama says he doesn’t perform cosmetic foot surgery: “If it’s not bothering you and it doesn’t hurt, my recommendation is to leave it alone.”

However, if pain doesn’t abate and a patient is experiencing symptoms such as restricted toe movement, minimally invasive surgery may be recommended to correct the bunion. With minimally invasive treatments, most patients with bunions can return to their everyday activities pain-free and are able to wear the types of shoes they want without discomfort, Dr. Rahnama said.

There are more than 100 ways to surgically repair a bunion, but there are two that are most common. In the first method, the surgeon physically shaves down the patient’s bump using a saw, makes small cuts in the bone and shifts the bone over and fixates it with screws. After this type of procedure, patients can weight bear almost right after surgery. However, if the bunion case is severe or the patient is very young, they can be susceptible to having a recurrence even after this procedure, Dr. Rahnama said.

With the second option, the surgeon fuses a joint near the midfoot — a place that doesn’t appear to show symptoms but is where the root of the bunion is. If the surgeon fuses the joint and straightens out the bone, the chances of recurrence decline, Dr. Rahnama said.

Depending on the type of bunion surgery, some patients would be able to bear weight the day after surgery in a boot. With more extensive procedures, the patient may need to avoid weight bearing for no more than three or four weeks.

It’s important to visit a doctor and get medical or surgical treatment because there can be ramifications if patients do nothing, Dr. Rahnama said. For many patients, the pain and the bunion can get worse if treatment is not sought; also, over time the big toe joint can become arthritic. Not consulting a doctor could yield more extensive surgery, too.

“If they wait too long, instead of having bunion corrective surgery, they would have to have fusion of that great toe joint. And while most patients do well with that, it would be great to avoid that with a lesser procedure if possible,” Dr. Rahnama said.

Many of Dr. Rahnama’s patients have been able to bounce back and lead normal lives after bunion procedures.

“Luckily most of our patients who undergo bunion surgery are able to get back to not only the things they like to do but also to wearing the type of shoes that they want to wear without discomfort,” he said. “The aim of this surgery is to be able to help them have a better quality of life.”

MedStar Washington Hospital Center’s specialists are available to help patients decide the right path for their treatment, Dr. Rahnama said.

“We have a very highly skilled team of surgeons who are more than equipped to treat patients and their foot and ankle needs,” he said.

Read more and listen to a podcast with Dr. Rahnama here.

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