Another very common foot condition that affects adults, and occasionally children, are bunions. A bunion is a condition that develops when the large toe, that is the one closest to the body’s midline, becomes enlarged with a painful swelling or “bump” where the toe joins the foot as the large toe begins to move closer towards the second toe. This “bump” becomes progressively larger and inflamed. This can make wearing shoes very uncomfortable and can cause pain in other areas of the foot.
The primary causes of bunions are:
- A hereditary predisposition to the development of a bunion; that is, somebody in the family has or had a history of bunions.
- Our general foot structure which causes a flattening of the arch during normal walking; especially on hard surfaces (pronation). This pronation causes excessive motion in the large toe joint, allowing the large toe to move over toward the second toe. This further creates an enlargement of the large toe joint or bunion. Shoes do not cause bunions, but may aggravate an already present bunion.
The course of treatment depends on the severity of the bunion. Conservative treatment includes wearing wider shoes, placing pads on the bunion area, or fabricating a functional foot orthotic device to stabilize the foot throughout the normal walking cycle and control the pronation. This is a device similar to the one mentioned for treating heel pain.
If conservative treatment fails, then surgical removal of the bunion is appropriate. This type of surgery can now be performed on an outpatient basis at a hospital or surgery center. Usually, this procedure can be done under a local anesthetic and walking can be resumed, with a special postoperative shoe, immediately following the surgery. It should be noted that with modern podiatric technology, most patients do not require any type of pain medication following this surgery and may return to work on a modified basis.
Pre-surgery photo of a bunionectomy and of a hammertoe repair to the 5th toe.