Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.
What is a Bunion?
A bunion (also referred to as Hallux Vagus or Hallux Abducto Valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework at the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. Also the first metatarsal (the bone in the foot that the big toe connects to) moves inward, away from the center of the foot. This throws the bones out of alignment – producing the bunion’s “bump".
Bunions are a progressive disorder. They begin with mild protrusion of the joint and a subtle leaning of the big toe. Gradually the angles of the bones change over the years and slowly produce the characteristic bump, which becomes increasingly prominent. Symptoms are usually mild at first, becoming more severe at later stages.
Bunions are usually hereditary. One inherits a faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.
The wearing of tight shoes that crowd the toes does not cause bunions (a common misconception), it can sometimes cause the deformity to get worse faster. Symptoms may, therefore, appear sooner.
Symptoms, which occur at the site of the bunion, may include:
- Pain or soreness
- Inflammation and redness
- Stiffness of the joint
- A burning sensation
- Possible numbness
Symptoms occur most often when wearing shoes and during periods of prolonged weight bearing. Women are more likely to have symptoms than men because their shoes tend to be snug. If the bunion has progressed to the point of arthritis (bunions and arthritis page is in the works) it will often hurt with or without shoes.
Bunions are readily apparent – the prominence is visible at the base of the big toe or side of the foot. However, to fully evaluate the condition, I will need to take x-rays to determine the degree of the deformity and assess the changes that have occurred.
Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike – some bunions progress more rapidly than others. In cases of a pronounced hereditary tendency, bunions can become severe in a teenager. Or, as is more common, they develop gradually over many years becoming symptomatic in mid-life. Once I have evaluated your bunion, a treatment plan can be developed that is suited to your needs.
Sometimes, periodic observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation and x-rays are advised.
In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions and slowing their progression, but they won’t reverse the deformity itself.
Treatment may include :
- Changes in shoewear. Wear wider and looser shoes. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition. As a general rule, lace-up shoes that hold on to your foot in the midfoot(instep) area is more forgiving to a bunion area than a loafer, slip-on type shoe, that grabs onto the ball of the foot.
- Padding. Pads placed over the area of the bunion can help decrease pain. Pads, however, require a roomy shoe or the tightness will make things worse. There are many different types of pads.
- Activity modifications. Avoid (if possible) activity that causes bunion pain, including standing for long periods of time.
- Medications. Oral anti-inflammatory drugs (NSAID'S) such as ibuprofen, may be recommended to reduce pain and inflammation.
- Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
- Orthotics. These custom made, mechanically corrective devices are used to treat many underlying flaws in foot function and can delay the progression of Bunion deformity.
Injection therapy. Although not a common treatment for bunions, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint), or sometimes as a temporary measure for bunions with arthritis.
When Is Surgery Needed?
If non-surgical treatments fail and when the pain of a bunion interferes with daily activities, it’s time to discuss the surgical options. Together we can decide if surgery is best for you.
A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the “bump” or bony protrusion, correct the changes in the joint structure of the foot, and correct soft tissue changes that may have also occurred. The primary goal of surgery is the reduction of pain. (link to surgical Bunionectomy coming soon)
In selecting the procedure or combination of procedures for your particular case, I will need to consider the extent of your deformity, the x-ray findings, your level of activity, your age, your weight, and your general health. The length of the recovery period will vary, depending on the selected procedure and the severity of the bunion deformity.
Corns tend to be smaller than calluses and are the hard center is surrounded by irritated skin. While corns can be found on the bottom of the foot where pressure is usually applied, it is more common that you find corns on the tops and sides of your toes and even between your toes. When pressure is applied, corns can cause significant pain and discomfort.
Calluses, on the other hand, don’t usually cause pain. They usually develop on the soles of your feet, especially under the heels or balls, on your palms, or on your knees. Calluses vary in size and shape and are often larger than corns.
In this condition, the toe is bent at the middle joint, causing it (with some imagination) to resemble a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with a hammertoe may have corns on the top of the middle joint of the toe or on the tip of the toe, or they may develop calluses on the ball of the foot. They frequently feel pain in their toes or feet and have difficulty finding comfortable shoes.
The most common cause of hammertoes is a hereditary tendency and muscle imbalance. Sometimes hammertoes form as the result of other conditions that affect the feet such as diabetes.
Initial treatment for the condition typically involves selecting roomier shoes with a bigger toe box. Commercially available straps, cushions, or corn pads may also relieve symptoms.
Hammertoe deformity tends to be gradually progressive. In many cases, hammertoe surgery may be recommended to correct the deformity.
Diabetic Foot Care
Diabetics are more prone to various foot problems than those without diabetes due to the development of painful nerve damage called peripheral neuropathy. Neuropathy can affect your entire body, but most often the legs and feet are the most prone areas to serious health complications.
The damage to your nerves can cause the loss of feeling in your feet, making it difficult to detect extreme temperatures and pain as easily, or readily, as someone who does not have diabetes. As a result, you could sustain a serious cut or wound and not even notice your foot is injured until an infection begins. Many diabetic foot problems can be prevented in some measure with improved blood sugar control and a strengthened immune system.
If you are among one of the millions of people in the United States with diabetes, it is important to visit your podiatrist for regular foot examinations in order to maintain healthy feet and a strong body.
Examine Your Feet Daily
Careful inspection of your feet on a regular basis is one of the easiest, least expensive and most effective measures for preventing foot complications. By examining your feet daily, and after every injury, you are taking a crucial step to preventing serious foot problems. Noticeable changes, such as temperature, skin color, pain, or swelling may be warning signs for poor circulation or loss of sensation that could potentially lead to something more serious.
Annual examinations by your podiatrist are also vital for anyone with diabetes. A podiatrist can provide a more thorough exam and detect any signs of changes, such as broken skin or ulcers that can be detrimental to the health of your feet and body. Your podiatrist can also check for areas of high pressure or loss of blood circulation.
Clean Your Feet
With diabetes, it is important to keep your feet clean. Wash your feet daily with warm water and mild soap. After washing, make sure you dry your feet thoroughly, especially in-between the toes. You may also apply non-irritating moisturizer to prevent cracks and to keep your feet smooth.
Be sure to also avoid ingrown toenails, which can get infected, by keeping them trimmed neatly. If you are unable to cut your toenails safely, ask your podiatrist for professional assistance. And never attempt to cut your own bunions or corns as this can lead to infection, as well. Instead, remember to visit your podiatrist for safe and pain free removal.
To further protect your feet from harm, be sure to:
- Avoid smoking, as it reduces blood flow to your feet
- Buy comfortable shoes that are not too tight or too loose
- Wear clean, dry socks and change them everyday
- Never walk barefoot in order to protect your feet from harmful objects
Diabetes is serious, especially when your feet are involved. Early detection and simple care are just a few things that can be done to control and prevent complications as they arise.
Your podiatrist plays a critical role in the prevention and management of complications of the foot in diabetics. Talk to your podiatrist today to see what you can do now to keep your feet safe, strong, and healthy.
Plantar warts are caused by the HPV virus and cause tiny cuts and breaks on the bottom of your feet.
While most plantar warts are not a major health concern, it is advised you see a doctor to have the warts examined and removed. Some symptoms include small, rough lesions on the base of the foot, calluses in one spot, and tenderness when walking or standing for long periods of time.
Heel Spurs/Plantar Fasciitis
Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.
Chronic ankle instability is usually caused by repeated ankle sprains and is described as the gradual giving way of the outside of the ankle. Some symptoms of ankle instability include constant inflammation or swelling, tenderness, and instability in the ankle. After a sprained ankle, the ligaments become stretched and torn. Proper rehabilitation is required to strengthen the muscles around the ankle and rehabilitate the tissues within the ankle that affect your balance. In addition, physical therapy, medications, and bracing can help treat chronic ankle instability. Failure to do so may result in repeated ankle sprains, or possibly surgery.
Flat feet is a common condition, it is estimated that approximately one quarter of the population has flat feet. Flat feet are normal in infants, but after approximately age 3 a normal arch should be visible. Not all flat feet are painful. But, if there is no pain, it doesn’t mean that this will remain so. Over time, and during periods of heavy use, a flat foot over-stretches, and overuses its own ligaments and tendons, resulting in pain and fatigue, and sometimes leading to accumulated permanent damage. A child with flat feet may not initially have pain, but may complain of fatigue in the feet, and sometimes display reluctance to participate in athletic activities. In such a case, the condition will become more symptomatic as an adult, and may lead to foot deformities, and sometimes ankle, knee and low back pain. Flat foot condition can go by many names including pes planus, fallen arches, (over)pronation, and posterior tibial dysfunction.
Once identified as the problem, initial treatment consists mostly of arch supports, or custom-made orthotics. More severe cases, may require surgery.
Athlete’s foot (tinea pedis) is a specific type of fungal infection that typically begins between the toes. A common cause of athlete's foot is sweaty feet that are confined to tight shoes for a long period of time. Signs and symptoms of athlete’s foot include a scaly rash that usually causes itching, stinging and burning. Athlete’s foot is contagious and should be carefully monitored and treated. Athlete’s foot can easily be treated with antifungal medications, but the infection is likely to recur. Prescription medications also are available.
Achilles tendinitis is caused by overuse of the band of tissues that connects the lower region of your calf muscle to your heel bone, also known as your Achilles tendon. Those at a higher risk for Achilles tendinitis are runners engaging in intense training or middle-aged people who participate in sports on occasion.
A neuroma can occur in many areas of the body when nerve tissue thickens. Morton’s neuroma is the most typical neuroma that occurs in the foot and it occurs between the third and fourth toes. Also known as an intermetatarsal neuroma, the name describes its location in the ball of the foot.
Compression and irritation typically cause the nerve tissue to thicken. This pressure creates inflammation of the nerve, ultimately causing untreatable damage to the nerves in the foot.
A sprained ankle occurs when you twist your ankle in an abnormal way causing the ligaments holding your ankle bones together to stretch or tear. Most sprained ankles involve injuries to the ligaments on the outer side of the ankle. Treatment for a sprained ankle depends on the severity of the injury. Although you may just need proper rest and pain medications to heal, it is important to have the sprain looked at by a professional to determine the severity and proper treatment.
Fungal infections in the toe or fingernails can appear as thickened, discolored, or disfigured. While it may seem like the condition is just an aesthetic concern, fungal infections can lead to worsened symptoms and pain. Diabetes, a weakened immune system, and the normal aging process are all causes associated with fungal infections. It is more likely for senior citizens and adults to develop a fungal infection as opposed to children.