As we age, we are at risk of developing a number of common foot problems including bone spurs, arthritis and ingrown toenails. However, one condition that stands out as particularly disruptive to patients’ lifestyles is bunions.
There are many common misconceptions surrounding the condition, some of which dissuade patients from seeking treatment. As a foot and ankle specialist, my hope is to dispel these myths and ensure that those suffering from bunions know that treatment options are available to provide them with relief.
Bunions are commonly believed to be a simple callous or overgrowth of bone on the side of the foot, but the condition is actually a complex bone deformity caused by unstable bones in the top of the foot. As the bones lean, elevate and rotate out of place, they allow the big toe to drift out of alignment. Over time, this misalignment creates the bunion’s telltale bump on the side of the big toe.
Many people believe that only older women develop bunions or that they are caused by wearing high heels. In reality, bunions can occur in anyone, regardless of age or gender. The deformity often runs in families and it’s estimated 70 per cent of Australians over the age of 60 suffer from them.
While women more commonly seek treatment for the condition because certain footwear—like high heels—can aggravate it, I have also treated many men and teenagers.
Bunions are a progressive foot deformity, so some patients may not even notice them when they first begin forming. Some patients first visit their provider to discuss the condition because they notice that they aren’t able to fit their feet into narrow-width shoes or high heels, or their shoes are wearing through quickly where the material rubs against their bunion deformity.
Over time, the condition often causes discomfort and pain that increase in severity. Bunions can also cause swelling, pressure and numbness throughout the foot. These symptoms tend to worsen when the toes are crowded in shoes or when a patient stands for long periods of time. Many patients who once enjoyed being active eventually have trouble walking and performing daily activities as their bunions worsen.
If a bunion goes untreated, it can lead to progressive deformity and additional complications including arthritis, calluses, the crossing of the toes, hammertoes, bone spurs, and pain in the ball of the foot.
When a patient is first evaluated by their podiatrist or surgeon, the provider will often recommend that conservative, nonsurgical options are used as a first attempt to manage bunion-related discomfort.
These include buying wider shoes, padding, braces, toe separators or orthotics to accommodate the deformity and reduce pain. Many patients also turn to over-the-counter pain medications such as ibuprofen and icing to ease their discomfort on a daily basis. If these options fail and the bunion is severe, surgical options are often discussed as the next step because they are the only way to correct the deformity in the long term.
Traditionally, podiatric surgeons have used a procedure called 2D osteotomy, also known as “Shave It Off” surgery, to treat bunions. The procedure involves shaving down the protruding bone on the side of the big toe and then cutting and shifting the remaining bone over.
This approach gets rid of the cosmetic bump on the toe but doesn’t address the unstable joint in the foot that caused the bunion deformity in the first place. These procedures can involve a recovery process where patients may remain non-weight bearing for 6 to 10 weeks. However, there is hope for easier surgical treatment, with a growing number of surgeons in the United States now performing a relatively new procedure called 3D Bunion Correction.
The procedure involves using a system of patented titanium plates to realign the displaced bones in the foot and secure them in their proper positions. The approach allows physicians to address all three dimensions of the bone deformity that causes bunions.
Over 65,000 patients have been treated with this procedure since its creation. Many of them are able to bear weight on their treated foot in a walking boot within two weeks after surgery, enabling them to get back to many of their typical day-to-day activities.
Within 6 to 8 weeks after surgery, patients are usually able to return to wearing comfortable tennis shoes. Around four to 6 months after their procedure, a patient is generally cleared to return to any physical activities they are comfortable doing, including walking, running, biking and skiing.
Patients are also pleased to see how well the procedure corrects the cosmetic aspect of a bunion. It is rewarding to see them be able to wear shoes that have sat in their closets for years!
Bunions can take a severe physical and emotional toll, but it is important for patients to know that treatment options are available to them. Since I began my practice in podiatry almost 10 years ago, my goal has been to help patients understand these options and return to the lifestyles they love as quickly as possible. I am pleased to have helped patients return to the lifestyles that they were previously unable to enjoy due to bunions.