Big, Bad, Bunions

by admin on December 10, 2011

Bunions are one of the most common, and commonly misunderstood, foot problems.  A bunion is a painful nodule that forms on the inside portion of the ball of the foot, often swelling and becoming more painful with shoegear.  It is associated with the great toe moving to the side and often overlapping the 2nd toe.  Some say it comes from having flat feet.  Some think it comes from shoe rubbing, like a callus.  Others think it is from collapsed arches.  Which is it?
Well, a little bit of the above is true.  At its root, a bunion is a prominence at the ball of the foot that is caused by the 1st metatarsal (the bone that the big toe is attached to) splaying out to the side, making the front of the foot wider.  So the bump that you see is not the skin swelling, or a callus forming, or a cyst of some kind.  It is actually the bone pushing out to the side, against the skin.
Why does this occur?  Primarily, the development of a bunion is related to a person’s individual anatomy; specifically, the relationship that the bones in the foot have to one another.  Now, there are 28 bones in the foot, so there are a lot of different combinations that can lead to a bunion!  Classically, the flatfoot foot type was associated with bunions, but not all people with bunions have flat feet.  (Nor do all people with flat feet have bunions.)  People who intoe (what used to be called “pigeon toed”) as children often end up with bunions as adults.  And these are just the genetic causes for bunions to occur.  Poor shoegear, specifically high heels (ladies!) and flat shoes with no arch support at all (guys!) is a big-time influence for bunions to form.  Also, tight or otherwise poorly-fitting shoes can have an influence.  Finally, age and activity level can be factors.  The chance of developing bunions increases with age (like everything else) and jobs that require a lot of repetitive walking movements or standing long periods (particularly on concrete) also have a crack at producing the chronic foot fatigue that can lead to bunion formation.
So say you come from a family with bunion-afflicted feet, you tend to be flat footed, and you wear high heels all day at your job at the local big box store.  Is there any hope?
Well, bunions prove the old adage “an ounce of prevention is worth a pound of cure.”  It may not always possible to prevent bunions from forming, but you definitely don’t want to give them any opportunities.  It is generally regarded that appropriate shoegear, arch support, and exercise (involving the legs and feet) are things that will slow the development of bunions, and they are fully within your control.  (As a sidenote, the barefoot running/walking craze may actually help to strengthen the muscles on the sole of the foot, which *theoretically* could reduce the chances of developing bunions.  Not that I am advocating taking up any new hobbies!)  Certainly, the setup for bunions is genetic, but the follow-through is all you.  If you’re getting this message early enough, take care of those feet, or you’ll be sorry!
So say I didn’t get the message in time, and I have bunions that hurt my feet all the time.  Can anything be done?  Well, I have good news and bad news for you.  The good news is, yes, a bunion is completely correctible.  The bad news is, the only way to accomplish this is with surgery.  I find bunion surgery to be another topic full of mis-information, and this could be because there is so much variety in the types of procedures that are done.  To give an example of the variation, with one procedure you are pretty much fully recovered after a month, whereas with another you are just getting off crutches at 6 weeks.  And unfortunately you can’t pick the procedure you want from a menu (otherwise probably everyone would choose option 1); everyone is different, and the reason for the variety of procedures is because each deals with a particular problem that caused the bunion and/or fixes problems that have developed in the meantime.  Unfortunately, it all depends on your individual situation.
If you want to find out more about your own feet, if you are at risk of developing bunions, want to prevent them, or need to have your feet fixed, visit your local podiatrist or orthopedic surgeon to get a full eval, and have all your questions answered.


mairead kenny June 20, 2012 at 9:46 am

Looking to get my bunion removed, Is it a big job and how long will be off work.

admin June 21, 2012 at 4:45 pm

It depends. Bunion procedures are outpatient, but what is actually done varies quite a bit so one person is back to work in a few weeks while another is on crutches for that long. The choice of procedure depends on the factors that caused the bunion to develop. In general, the longer it has been there and the younger you were when it started, the more involved the procedure is.

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