Dear Doctor: My aunt told me she has a painful bunion. What is that?
A bunion is large bump that forms at the base of the big toe where the bone of the big toe attaches to the bones of the foot. When this happens, the big toe usually bends inwards, sometimes at a very extreme angle. The bone of the foot, called the metatarsal, gets pushed outwards forming the bump, called a bunion.
It can become very painful and affect walking and the ability to wear shoes. Bunions can occur on any toes, but they most commonly occur on the big toe. When it happens to the little toe, it is called a “sewer’s bunionette” or “tailor’s bunion” from when people who sewed crossed their legs for long periods of time.
Why should I care about bunions?
They are quite common, affecting about three-to-five percent of all people. They can occur in anyone, but they occur most commonly in women. Because of their extreme discomfort and pain, they can greatly affect activities of normal living if not treated.
What causes bunions?
Bunions usually start to develop in early adulthood and get worse over time with repeated pressure on the foot. Bunions can run in the family and can be caused by poor or weak foot structure. Bunions are more commonly seen in people with arthritis and people with uneven leg length (bunions usually develop in the longer leg).
As mentioned, women are more likely to develop bunions. The repeated wearing of tight, poorly fitting shoes with pointed toes and high heels are a major cause of bunions. Over time the shoe forces the bones of the foot into an unnatural shape, causing the bunion.
How are bunions diagnosed?
Bunions have a classic appearance, and a foot doctor will be able to make the diagnosis. Additionally, x-rays may give additional information as to the extent of the bunion, leading to a better treatment recommendation. The doctor may order blood tests to see if arthritis is also involved in the condition.
Can bunions be prevented?
Bunions develop slowly over time. If you have a family history of having them, taking great care of your feet during childhood and early adulthood can pay rich rewards when it comes to foot comfort and health in later life and go a long way to prevent bunions.
Exercise regularly to build foot strength and avoid wearing any tight, poorly fitting shoes, especially high heels with pointed toes. If you notice any changes in the shape of your feet, see a foot doctor right away.
How are bunions treated?
If the bunion is small or not painful, custom-crafted, special-fitting shoes may be the only treatment required. Your doctor may also recommend special pads or inserts with the shoes.
If the bunion is painful, in addition to over-the-counter pain relievers, a prescription-strength pain reliever and anti-inflammatory medication may be prescribed.
A heating pad, warm tub soaks, and even ice packs can also bring temporary relief.
As a last resort, surgery may be recommended for painful bunions when the other measures are not working. Surgery for a bunion, called a bunionectomy, is a very complicated surgery that does carry risks. Depending on the severity of the bunion, sometimes bone will be removed and screws inserted.
This type of surgery is done in a hospital or surgery center and should be performed by a surgeon with bunionectomy experience. Sometimes the bunion may return and additional surgery will be required.
After examining your condition, your doctor will recommend whether you need orthopedic shoes, custom-made inserts, medication, surgery or other treatment.
Action steps for anyone with a bunion
Make an appointment to see your doctor. Bunions only get worse over time, and starting treatments now may save surgery in the future. It is important to develop a treatment plan with your doctor and stick to it. If bunions run in the family, educate your children about bunions and ways to prevent them.
Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.