My Bunion Hurts

A bunion is a very common condition in the foot and ankle that affects approximately 23% of the population. It is most notably characterized by a painful, red, bump along the inside of the great toe. The bunion actually got its name from the Greek word for “turnip,” the reddish-purple root vegetable, because of its similar appearance. Contrary to popular belief, a bunion is not just a bump or extra bone, or even a bony growth. A bunion is actually a complex deformity in which the great toe proximal phalanx moves into a valgus position (towards the outside of the foot) and the metatarsal bone moves into a varus position (towards the inside of the foot).

You may hear your orthopedic surgeon call this “hallux valgus.” Hallux, for “great toe,” and “valgus” for the laterally deviated position of the toe. Over time, the toe can also start to rotate. For example, you may find that your toenail no longer faces the ceiling, but is now rotated towards the inside of the foot. The great toe can also abut, crossover, or cross-under the second toe. Some patients even develop numbness and tingling due to stretching of the nerve along the bony prominence.

The bunion deformity is more commonly seen in females, but males can also be affected. Many think it is caused by wearing high heels or shoes that are too tight. While this may play some role, there are many other causes, as well. For example, 70% of patients with a bunion actually have a genetic predisposition. Meaning, if you do have a bunion, ask your parents, grandparents, aunts, uncles, cousins...it is very likely that you will find some similar looking feet in your family tree. A bunion can be associated with other conditions of the foot and ankle, such as ligamentous laxity, flatfoot, or rheumatoid arthritis. Some patients are born with their bunion deformity, called the adolescent-type, and is often present on both feet.

In most cases patients want to know if their bunion is going to keep getting worse, and what they can do to prevent that from happening. Unfortunately, there is no way to prevent or correct the bunion without surgical intervention. But that does not mean that you necessarily need surgery. The good news is that your bunion deformity may not ever change or even progress. Every patient is different. So, if your bunion doesn’t cause you any pain or disability, then it is perfectly reasonable to manage this conservatively and wait to see a provider once you start to have discomfort. In fact, many patients live their whole life without ever having any substantial symptoms from their bunion.

If your bunion does become painful, there are a few things you can do to try and manage these symptoms: 

• First line treatment always includes activity and shoewear modification. A shoe with a wider toe box will help reduce pressure on the great toe. Additionally, a toe pad or toe spacer to help cushion the great toe may also be helpful. 
• Most of the time various pain medications such as Tylenol and non-steroidal anti-inflammatories, or topical creams such as Voltaren gel or arnica cream can be used to help relieve symptoms. 
• You may find an assortment of different over-the-counter devices online that will advertise being able to correct the bunion or make it better. Take caution, as these devices have no scientific evidence to support them. While they likely will not do any harm, they can be expensive and lead to false hope. Be sure to speak with your foot and ankle provider if you have any specific questions.

Once a patient fails non-surgical treatment, he or she can have a discussion with their surgeon about what the next steps are. Surgical management depends on the degree of deformity, associated conditions, and the surgeon preference. There are over 15 different surgical options to treat a bunion, including a minimally invasive approach in which the bunion is corrected through small stab incisions that each require only a single suture to close. It is important you speak with your foot and ankle surgeon to determine what the right form of correction is for you.

If you are ready to take the next step to having a pain-free step, please schedule an appointment with myself, or one of my Foot & Ankle colleagues here at Rothman Orthopaedics.

Dr. Moncman is a fellowship-trained orthopaedic surgeon specializing in the treatment and conditions of the foot and ankle. She sees patients in Orlando, FL and Lake Mary, FL. For more information, click here.