It's a common misconception that bunions are caused by high heels and tight shoes, says Dr. John Senatore, chief of podiatry and a sports-medicine physician at Union Memorial Hospital. Stilettos and narrow toe boxes can aggravate those unsightly protrusions, but they are caused by foot type, says the veteran marathoner, a frequent lecturer on foot-related injuries and treatments.
What is a bunion?
The term "bunion" is derived from the Latin bunio, which translates into "turnip." The term is loosely applied to any enlargements of that big-toe joint. You can also have a "dorsal bunion" on top of the foot or more commonly the bunion on the side. Then there is also the bunion on the fifth metatarsal called a bunionette or a "tailor's bunion."
How can foot type cause bunions?
Usually, people with a flat foot will develop a bunion on the side of the big toe, and people with a relatively higher, straight foot would develop the bunion on top of the big toe.
Can bunions be hereditary?
The foot type is hereditary. If you got your flat feet or high arches from your parents, then bunions may develop as you get older. That's why when I recognize early bunion formation, I try to put patients in an orthotic. That would slow things down.
As a deformity, do all bunions impede mobility and body mechanics?
If anything hurts, it's going to impede your mobility. If the prominence of the big toe rubs in the shoe, causing swelling and irritation, that in itself can cause pain and change the way you walk. There can also be changes that occur in the joint that can cause arthritis.
If untreated, do bunions get worse over time?
Absolutely.
How do you treat bunions?
I will try to alleviate the discomfort by reducing the pressure on that joint with an orthotic device and advise changing the shoe type if it is really tight and rubbing.
Are specific shoes suggested for bunions?
You look first for a shoe that has a wide and fairly deep toe box that can accommodate the deformity. Second, you want a shoe that has a decent arch support, especially for those dorsal bunions. You really want to avoid a very flexible, flat shoe. And you want a thicker sole that doesn't bend and that will help to unload pressure on the joint and the bunion.
Is there one shoe or style of shoe that should be avoided?
I am not too popular with teenagers. I will insist that they avoid flip-flops as their main choice of shoe wear. They are, without question, the worst possible shoe choice for anyone with an injury or a deformity on their foot.
How do orthotics alleviate bunion pain?
They realign the foot and can unload or remove pressure from that joint, and that alleviates a lot of the discomfort. Orthotics are similar to eye glasses; they only work when you wear them. And it is a challenge, especially with women, to accommodate all shoe styles.
What should athletes do about bunions?
You want to avoid surgery unless the pain impedes performance. When surgery is performed to correct a bunion, you're going to lose some motion at the great toe joint. For an athlete, that loss may affect their performance.
When do you recommend surgery?
You really want to avoid surgery at all costs. First, you should exhaust all conservative measures. If you can't fix it with shoes and orthotics and the pain forces you to limp, then we've got to go in.
When should you seek medical advice about a bunion?
I would say the earlier you come in and seek treatment, the better.
Can a bunion grow back after surgery?
They can come back. Again, you're not changing the foot type. The mechanics behind that are still there.
What is the most common bunionectomy?
The most common bunionectomy procedure involves an osteotomy, and that's breaking the bone and realigning it.
Describe the recovery period for a bunionectomy?
I would say about at three months you're 75 percent better, and then from six to nine months you're 90 percent better. I typically keep most of my patients in a protective surgical shoe for about six to eight weeks and gradually return them to a soft shoe and then to regular shoes.
Are there any exercises you can do to prevent bunion growth or pain?
Not really.
Are there any braces or stretching devices that can correct bunions?
There is nothing that is going to change a structural deformity. Without surgical correction, that kind of relief is only temporary.
Do you perform bunionectomies for women who want to fit into their Jimmy Choo shoes?
I absolutely refuse to do cosmetic surgery. It's not covered under insurance. And you could take an ugly foot that doesn't hurt and turn it into a pretty foot that is painful, or have complications. Why take the risk?