Expert advice: Everything you need to know about bunions

Oct 28, 2019
Bunions can appear as a bony bump on the side of the foot. Source: Getty

Bunions are one of the most common foot problems among older Australians because they’re a natural part of ageing. But, other than knowing that bunions can appear as a bony bump on the side of the foot, many people don’t know why bunions form or how they can be treated.

We chatted with Sydney-based podiatrist Dr Frances Henshaw to find out more about the painful condition and what you can do about it.

Bunions explained

Bunions may sound like a small matter but they can be incredibly painful – even when you are sitting or lying down – and make it difficult to find shoes that fit without putting more pressure on the area.

In simple terms, a bunion forms when the joint of the big toe moves out of place due to pressure, causing the affected toe to develop a bulging bump and point outward towards the other smaller toes, Henshaw tells Starts at 60. They can also form at the base of the little toe, where they are called a bunionette.

Because bunions are a progressive deformity, they usually get worse, and, in some cases can even lead to more serious problems such as arthritis in the affected toe. Studies have also found that people who have bunions are more likely to experience hip, knee and leg pain, Henshaw explains.

The most common symptoms of bunions include swelling, redness or soreness around your big toe joint, thick skin on the underside of your big toe, calluses on your second toe (often caused by your big toe and second toe overlapping) and persistent foot pain.

The causes and risk factors of bunions

Henshaw says there’s a big misconception when it comes to the causes of bunions – many people think that bunions are caused by shoes, especially high heels, but according to Henshaw, “bunions are in fact hereditary” and have nothing to do with fancy footwear. Bunions can develop as a result of an inherited structural defect in the foot.

However, if you’re prone to the condition, wearing high heels can encourage their development, she explains, advising women to save narrow high-heeled shoes for special occasions and opting for more comfortable and supportive footwear, such as running shoes, for every day. When wearing heels, “the blanket advice is try and keep your heel under about 3 centimetres” which will reduce the pressure being forced onto your toes.

While anyone can develop a bunion, they’re more common in women, people with flat or low arches and rheumatoid arthritis. The other main risk factor for bunions is age – in fact, 30 per cent of people aged 50-60 have bunions, Henshaw explains.

How to treat bunions

Surgery is the only way to correct a bunion, but whether you require surgery would likely depend on the severity of your bunions, and for many people there are non-surgical options worth exploring first.

Non-surgical treatments include painkillers, such as paracetamol or ibuprofen, bunion pads and splints, as well as wearing suitable footwear. When choosing the right shoes, Henshaw says you want a pair that have a deep and wide area for toes, which will eliminate any rubbing or pressure on your bunion. Consider using a padded shoe insert that will evenly distribute the pressure around your foot when you move. And if your bunion becomes inflamed, ice packs can help to reduce swelling (a bag of frozen vegetables works well too).

While non-surgical treatments may help relieve pain, they can’t improve the appearance of your foot or prevent a bunion from getting worse, she explains. In this case, surgery is another treatment option. Bunion surgery is often carried out as a day procedure, meaning you can go home the same day, and it’s usually done under local anaesthesia.

There are three main types of surgery: an osteotomy, an exostectomy or an arthrodesis.

  • In an osteotomy, the surgeon will cut the big toe joint and realign it
  • For an exostectomy, they will remove the bunion from the joint without realigning the joint itself
  • For an arthrodesis, they will replace the joint with a metal joint, using screws or metal plates to correct the deformity

Before surgery, the podiatrist will usually refer the person with bunions to a podiatric surgeon, but if you want to see an orthopaedic surgeon you will need a referral from a GP, Henshaw explains.

The recovery time can vary from patient to patient, but it generally takes about six to eight weeks to fully recover. In your first few weeks of recovery, you’ll be given a surgical boot to wear. Then, you may need to wear supportive runners for another three to four weeks before switching to regular footwear.

When it comes to the cost, Medicare can help, but because bunion removal surgery isn’t considered high priority, there’s a waiting list, “so most people do it electively”, Henshaw explains. The procedure can cost anywhere from $2,500 to $3,500.

So, how effective is bunion surgery? Most people who have the surgery report an improvement, Henshaw explains, with their big toe going back in line with the others, however bunion reoccurrence is a possibility – previous studies have reported reoccurrence rates of up to 25 per cent.

IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.

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Have you had bunions before? How did you treat the condition?

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