You see them on bare feet at the beach or poking through sandal straps. Or you notice tell-tale bulges at the sides of someone’s shoes. Bunions are bony bumps that develop at the joint of the big toe. They may be painless or aching, slightly unsightly or increasingly deforming. Bunions widen feet and narrow shoe choices, dooming people to a lifetime of sensible flats with roomy toe boxes.
For some people, bunions are no bother, but for others, bunions hamper mobility, reduce activity and affect their quality of life. Below, specialists explain options for treating bunions and advise when — and when not — to consider bunion surgery. And if you think you would just breeze through surgical recovery, a former patient can set you straight.
Sarah Wagner, 35, of San Diego is celebrating her one-year anniversary after bunion surgery. Wagner is happy to announce she’s finally back to normal, but even so, it’s been a difficult year.
Wagner had a bad bunion on her right foot. When she could no longer take her kids for a day at the zoo without her foot throbbing with pain, she decided to see a podiatrist. “My life was becoming less active,” she says. “I did a half marathon, and it was just constant pain. I was tired of it.”
By then, Wagner says, her big toe was starting to cross over her second toe, and she had to wear a spacer in her shoe to keep her toes apart. But her barefoot beach lifestyle made that impractical. And the spacer didn’t help enough when she was running, as the side of her shoe rubbed against the bunion, making it blister.
Bunions run in Wagner’s family, on her father’s side. He had considered bunionectomy for himself, Wagner says, but changed his mind after witnessing his daughter’s recovery, which she describes as long and pretty intense.
The procedure Wagner had was called a “right foot bunionectomy with distal metarsal osteotomy.” “The first couple weeks you’re on major painkillers,” Wagner says. She spent that time lying in bed with her foot propped up on a pile of pillows.
Wagner wore a surgical boot for many weeks, which meant she couldn’t drive. There was one perk, she admits: “Actually, it was kind of nice because I didn’t have to go grocery shopping. ‘Sorry, I can’t — my foot, you know.'” Eventually, she graduated to a walking shoe.
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Bunion Mechanics
The medical term for bunions is hallux valgus. The affected big-toe joint is the metatarsophalangeal, or MTP, joint. That’s where the long metatarsal bone of the foot connects with the first phalanx bone of the toe. If these bones shift out of alignment, bunions form, as the MTP joint gets bigger and sticks out from the rest of the foot. The bunion can turn swollen, red and painful. Some bunions progress to the point where the big toe crosses over or under the second toe. In advanced cases, cartilage may wear away as osteoarthritis develops.
A common misconception is that bunions are just for seniors. One type, called an adolescent bunion, is most common in girls ages 10 to 15, according to the American Academy of Orthopaedic Surgeons. Adult-type bunions can show up in adults at any age, from their 20s onward.
“Genetics has a strong role in bunions, so the best way to figure out if you’re going to have bunions is to look at your mom’s feet or your grandma’s feet,” says Dr. Alexe Page, an orthopedic surgeon in private foot and ankle practice in San Diego. Women are more likely than men to have bunions, Page says. The same elasticity of connective tissues that makes women more limber also makes their feet more vulnerable to the forces behind bunions. While heredity is the major factor, continually wearing poorly fitting shoes that force the toes into certain positions can lead to bunions, as can certain medical conditions like rheumatoid arthritis. Congenital foot deformities may also cause bunions.
Professions that have people on their feet all day don’t really cause bunions, Page says. And high-heel shoes (which she admits to wearing on occasion) aren’t the primary culprits either. “There are things that will make bunions worse, and one is wearing high heels,” she says. But that was more the case in previous generations, she adds. “When women would try to jam their feet in a small-size shoe with high, high heels, that could make the deformity worse,” she says. “But they had to have had the predisposition for it.”
Men do get bunions, although they appear less likely to seek treatment. “I definitely do surgery on men, but it’s probably about 25 percent or less,” says Dr. Lawrence Silverberg, a foot surgeon at City Footcare in New York City. The simple reason, he says, is that men’s footwear is more likely to have space to accommodate the bunion, while women’s shoes tend to be narrower and also show more of the foot.
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When to See a Specialist
“There are basically three reasons people come to see me for [bunion treatment],” Silverberg says. “One is its cosmetic appearance. Two is that it does not fit into shoes anymore. And three, it’s painful. It limits their ability to exercise and perform activities.”
Two kinds of pain are related to bunions, he says. One is when the shoe rubs on the bone, and the other is arthritic pain within the inflamed joint. For early symptoms, Silverberg recommends conservative treatments to ease pain and prevent bunions from getting worse.
“The best thing to do is have custom-made orthotics,” he says. Podiatrists take scans and make molds of the foot to create precisely shaped shoe inserts. These can help the foot function more normally and help counter the forces that cause bunions to form over time. Cortisone injections also reduce pain, Silverberg says, while surgery a last resort.
Don’t bother buying plastic braces or toe separators sold online to help with bunions, Silverberg says: “Those things don’t work.”
When pain persists with conservative treatments, including anti-inflammatory drugs like Advil and Naprosyn; when activity becomes increasingly different or when foot deformities develop, it might be time to discuss surgery. An orthopedic surgeon or podiatrist who specializes in foot and ankle care can walk you through the different procedures to determine which, if any, is right for you.
Make sure you get a realistic idea of what to expect during recovery, which will depend on the severity of the bunion. “The recovery is generally about a month of time in a boot,” Silverberg says. “People who have desk jobs take a week off from work.” Patients who stand a lot on the job, such as retail workers or nurses, would take about four weeks off, he says, while first responders like firefighters might need up to 10 weeks off work.
Swelling is a big issue after surgery, Page says. “Elevation, elevation, elevation” of the affected foot is key for reducing swelling in the two weeks immediately after surgery, she says.
Silverberg says the majority of his bunion surgery patients are in their 30s and 40s. However, he says, people in their 20s may push for surgery as soon as possible. “A lot of times they want to fit into cuter shoes, because it’s New York City,” he says.
One debate around bunion surgery is whether it should be done for cosmetic reasons alone, when a patient isn’t experiencing pain or other problems. Things can go wrong with any surgery, and there’s potential for creating pain where none existed before, Page says. “We do surgeries to get people back out doing sports; back out doing activities,” she says.
[See: 7 Surprising Things That Age You.]
Surgical Aftermath
Wagner’s surgical procedure left her with a permanent screw in her toe. In her case, it took about eight months before she was entirely pain-free. Her return to full activity has been gradual. While she hasn’t quite resumed her previous running routine, she’s getting her workouts in other ways, like high-intensity interval training, or HITT.
While Wagner didn’t undergo bunion surgery to improve her foot’s appearance, that turned out to be a nice bonus. By the time she had gone to surgery, she says, she was becoming embarrassed. “Sometimes I’d cross my other foot over my giant bone sticking out.” Today, she says, other than a barely-there scar, her right foot looks just like the left. “Before the surgery, I never could have imagined having a normal-looking foot,” she says.
People should know that “bunions are not just for old people,” Wagner says. “Everyone was so shocked. They were like, ‘You have bunions — isn’t that a grandma thing?’ And I’m like, ‘Apparently not.'”
Wagner says she probably would do it all over again. “But if you had asked me that a couple months ago, I would have said no,” she adds. She wants other people considering bunion surgery to go in with their eyes wide open. “If you’re willing to work through the short-term pain to have comfort the rest of your life, then it’s a great choice,” she says.
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Bunions: No Fun for Your Feet originally appeared on usnews.com
