Bunions: The Bumpy Reality Of Foot Pain

Bunions are a common foot problem that can severely impact one’s daily life. Fortunately, there are various treatment options available ranging from non-surgical interventions to surgical procedures. These specific treatments are targeted to address the severity of one’s symptoms.

Jason Rosenblum, DPM, a Munster, Indiana, podiatrist at Franciscan Physician Network, discusses what is a bunion, symptoms of bunions, treatment options up to bunion surgery, alleviating discomfort, and how to slow down the progression of bunions.

What Is A Bunion?

A bunion is a deformity of the first big toe joint of the foot.

“There are different degrees of bunions. There are mild, moderate, and severe ones,” Dr. Rosenblum said. “I could have patients come in with a really severe bunion and no pain, and I could have patients come in with a very mild bunion with severe pain. So, that kind of helps us decide on what we need to do to treat it.

“Essentially, in the deformity, the long bone, which is called the first metatarsal, over time, many, many years, starts drifting outward, and it causes the big toe to start drifting inward and kicking the second toe out of its spot, essentially, and that can cause pain.”

What Causes Bunions?

The main cause of bunions is genetics, so it is passed down from one generation to the next.

“There definitely can be made worse by poor shoe gear and, different degrees of activity and how much you're on your feet,” Dr. Rosenblum said. “But if you're going to get it, you're going to get it.”

Why Are Bunions Painful?

Bunions can be extremely painful due to the first metatarsal in the foot drifting outwards, which then causes the big toe to drift inward. Due to the inward shift, the second toe moves out of its original position.

Bunion pain can be made worse by wearing poor shoes that are far too tight or have improper arch support, such as flip-flops.

How Do You Treat Bunions?

There are several ways to treat a bunion without having to undergo bunion surgery. These tactics specifically help slow down the progression of a bunion.

Footwear For Bunions

First, it is important to have proper footwear, which means wearing shoes that are not narrow and have arch support. Wear shoes with padding for extra cushion and comfort.

People can wear custom molded orthotics if they are still experiencing pain.

Medications For Bunions

Some people have success slowing down the progression of a bunion without having surgery by using anti-inflammatories, such as:

• Topical anti-inflammatory lotion or gel

• Oral anti-inflammatory such as ibuprofen

• Steroid injections, if severe enough to need

“My goal is to work with the patient, help them with their daily activity to try to decrease the pain,” Dr. Rosenblum said. “And then if we are unable to, then we will talk about surgeries and ways to improve it that way.”

Bunion Surgery

When it comes to surgical procedures, there are two main approaches to treating bunions.

The first approach is known as a bunionectomy, which a surgery to remove the bump to fix the deformity in the foot. An X-ray is done before surgery to see how much the bone has shifted from its original position, view the integrity of the joint space, and to see if any arthritis has formed in the foot.

“A mild bunion often can be treated with a procedure that's more towards the toes, and that usually consists of a surgery where you have to break the bone, actually move the bone over back into its normal alignment and insert some sort of hardware like a pin or a screw or a plate to hold that,” Dr. Rosenblum said. “The more severe the bunion, the farther back on the foot we have to go to actually fix it.”

The second bunion surgery is known as a lapiplasty, which removes the bump on the toe and stabilizes the joint at the base of the big toe. It has also helped patients to get back on their feet and walk much sooner than they had before. With this procedure, it is rare for the bunion to return.

When it comes to recovery time, post-surgery it is dependent on the patient’s age, activity level, what they do, and what surgery they received. When treating a mild bunion, the patient is typically off their foot, wearing a cam walker boot to relieve the pressure, and use crutches for about two weeks. Dependent upon what procedure was performed, the patient could just use the walking boot after the two weeks are up for another two to four weeks. For the more severe bunions, it is expected to be in a boot for four to eight weeks.