Bunions are one of those things that you never think about until it happens to you. And if this aching, painful foot-bone protrusion (which is also called hallux valgus) does happen to you — and it is one of the most common foot disorders out there — you’ll be hard-pressed to get it off your mind. For starters, bunions can really hurt. And, if left untreated for too long, the only option to truly correct them is surgery.
Thankfully, if you catch and treat bunion development early, there are certain precautionary foot care measures that can help prevent them from getting out of hand. (Here’s a hint: Your choice of footwear is crucial.) To find out more, we consulted a slew of experts for the details on this super-common yet infrequently talked-about foot condition. Orthopedists Steven Weinfeld, Chief of Foot and Ankle Surgery at The Mount Sinai Hospital in New York City, and Elizabeth Cody, foot and ankle surgeon at the Hospital for Special Surgery in New York City, plus podiatrists Hillary Brenner and Emily Splichal explain how a bunion is caused, treated, and if it can be prevented from ever forming in the first place.
Very simply speaking, "A bunion is a bump at the base of the big toe," Brenner says. Picture your big toe leaning sideways, toward your other four toes, and a large bony protrusion sticking out in the other direction — that's a bunion.
More specifically, "A bunion is the result of your first metatarsal bone gradually shifting out of alignment," Cody explains. "As the first metatarsal shifts, the big toe in turn starts shifting the opposite direction, towards your other toes." A similar bump can also form on the outside of your foot, on the base of your pinky toe; when this happens it's called a bunionette or "baby bunion."
This bony bump isn’t just painful; it can also lead to much more serious consequences if left untreated. "As the [big] toe starts to lose its alignment, the joint shifts off of the joint surface, increasing the risk of cartilage damage or arthritis formation," Splichal says. In other words, if bunions get out of hand, they can contribute to arthritis, a chronic condition, forming in the feet.
In sum, "if left unaddressed, a bunion can lead to other problems such as hammertoes, other second toe deformities like a 'crossover' toe, and mid-foot arthritis," Cody says. "You may also get more pain under the ball of your foot."
Experts actually disagree on what causes bunion — specifically, whether or not it can be truly caused by wearing tight, overly narrow, or high-heel shoes. But we do know that bunions are more common in women. So, most likely, it a combination of factors can lead to the development of bunions. "It is usually genetic in nature but is exacerbated by shoe wear," Weinfeld says.
One thing is certain: "Bunions that are left untreated usually progress over time," Weinfeld explains. So, if you start to feel any joint pain or notice a bump beginning to form, head to an orthopedist ASAP.
Warning signs to look out for include numbness, swelling, aching, redness, and calluses along the outside of your big toe; your big toe crossing underneath your second toe; and/or pain starting to transfer onto your second toe. Of course, the biggest sign is if the joint and bone on the outside of your big toe begin to protrude outwards.
"If you notice that you have a bump over the side of your big toe that is painful and rubs in shoes, you probably have a bunion," Cody explains. "Your big toe rubbing against your second toe, even when you don't have shoes on, is another sign."
The easiest at-home remedies to start with are daily Epsom salt soaks, switching to wider shoes, and wearing sneakers with inserts. If your feet are still in pain after trying all that for a while, go see your doctor. The first line of treatment from there will likely be orthotics. "The nonsurgical treatment for bunion includes shoe wear modifications and orthotics to alleviate pressure over the bony prominence," Weinfeld explains. "The only way to [truly] correct a bunion is by surgical means."
If surgery is necessary, it usually involves shaving off the bump itself as well as realignment of the bones of the foot, Weinfeld says. (Ouch.) Sometimes, even if the patient has bunions on both feet, these surgeries are done one foot at a time so the patient can use crutches rather than a wheelchair. Full recovery can take weeks to months.
"The benefit of surgery is that you are changing the structure of the bunion," Brenner explains. "With conservative care, you are putting a band-aid on the bunion in a sense; you will not take the bump away, just help with the pain of the bunion."
Some good news: There are some minor lifestyle changes that can help keep bunions at bay, at least a little bit. To prevent them from ever forming in the first place, Cody says that "wearing shoes that give your toes space and don't squeeze your feet is probably the best thing you can do!"
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