Everything to Know About Bunions

by David Macias, M.D.

Everything to Know About Bunions

Bunions are a bump on the inner edge of your foot, where your big toe connects to the rest of your foot. Bunions are caused by the bones in your foot moving and creating an angle. Bunions are common and are mostly caused by genetics. If your family members have bunions, you’re more likely to have bunions. They can also be caused by the shoes that you wear, but that’s not as big of a reason as family history.

Bunions are more common in women, but that may be because of underreporting in men. It’s much easier for men to hide a bunion and to accommodate it with the shoes they wear.

Symptoms of Bunions

The number one symptom is pain at that prominence on the inside part of the foot. You can also get swelling and redness at that prominence and you can have difficulty wearing some shoes.

Treatment of Bunions

Nonsurgical Treatment

The main way we treat bunions is accommodating them by buying wider shoes. Most people know that a size ten shoe is bigger than a size nine shoe. However, that number refers to the length of the shoe. There are also different widths for shoes, which generally go from AA to EE.

If you have a bunion, buying a shoe that has a wider toe box is the first step. Another treatment is to take over the counter medicines such as Tylenol or ibuprofen, if you can tolerate them, to help with bunion pain

You can use a pad to help protect that area to take some of the pressure off. And you can use an accessory like a toe spacer or a toe strap to try to pull that bunion back over. Spacers or straps cannot correct a bunion, change a bunion, or prevent a bunion from getting worse. They can make you more comfortable and make it easier for you to tolerate the bunion but once you take them out, the bunion will come back over into its original position.

Over time bunions get worse, but the time period that they change over is different for every person.

Bunion Surgery

Deciding on Bunion Surgery

If the nonsurgical treatments don’t work to help you with your bunion pain, then you can consider surgery.

Whenever I talk to patients about surgery, I ask four questions.

  1. Is there a surgery we can do to treat this problem?
    Yes, there is a surgery for bunions. There are some problems that are better treated with physical therapy, some with medication, but for bunions, there are surgeries we can do to correct the bunion.
  2. Are you getting pain every day?
    If you’re getting pain once every six months, once every year, or only when you wear a certain pair of shoes, I don’t think it is worth it to undergo the bunion surgery for minimal pain like that. However, if you’re getting pain every single day or almost every single day, then that’s more of a serious problem.
  3. Have you failed treatments that are not surgery?
    For bunions, have you tried buying wider shoes? Have you tried medications? Have you tried pads?
  4. Has this problem affected your quality of life? Does it prevent you from doing the things you want to do?
    For example, I don’t want to go on vacation with my family because I know my foot’s going to hurt and I’m going to have to sit down frequently. I don’t want to go work out. I don’t want to go hiking or exercising with my loved ones.

If a patient answers all four of those questions yes—yes, there is a surgery I can do to correct my problem; yes, I get pain every day; yes, I’ve tried things that are not surgery to make it better; and, yes, it affects my quality of life—then I think a surgery is reasonable.

Minimally-Invasive Bunion Surgery

The bunion is not a bump but a change in the angle of the bones in the foot. To correct the bunion, we have to change that angle.

There are many different ways to do this correction. I used to do a more traditional, open correction which got great results. However, there was a lot more disturbing the soft tissues and more pain. As my practice has evolved, I’ve moved to doing all my bunion corrections in a minimally invasive fashion using small incisions and special instrumentation through those incisions to cut the bone and correct it, disturbing the rest of the foot less. Often with these minimally invasive corrections, we have less soft tissue dissection and therefore less pain and faster recoveries on average.

After you have surgery to correct your bunion, I see you about every 10 days. I do all your dressing changes. I put you in a special shoe that you wear for the first four to six weeks. After that time, you switch to a roomy, comfortable, supportive tennis shoe. Between 10 to 12 weeks you can normally return to wearing regular shoes.

FAQs

What is lapiplasty?

Lapiplasty is a way to correct a bunion where you fuse a joint in your foot. It is a great way to correct a bunion but it is not my preferred technique. You can get excellent correction using it but I’ve found that I get equal corrections doing this more minimally invasive technique and using smaller incisions.

Does icing bunions when they’re painful help?

Yes, icing a bunion that’s painful can help reduce pain. It will not change the bunion.

I have bunions on both feet. Would you recommend having them repaired at the same time or one at a time?

I recommend doing them one at a time because you literally want to have one good foot to stand on.

I love heels. If I get my bunion repaired, will I be able to wear heels again?

Absolutely. I think one of the benefits to bunion correction is to be able to get back into wearing the things that you like to wear and the activities you want to do. If wearing heels is something that’s important to you, I think it’s a very reasonable goal to be able to get into heels after bunion correction surgery, if that’s the procedure that you need.

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