What are the best treatments for bunions?
Bunions are bumps of the inside of the foot at the big toe joint. The medical word for bunions is hallux valgus. The bunion deformity occurs when you have loose joints near the base of your big toe which causes the first metatarsal bone to drift away from the rest of your foot. The big toe then drifts outward toward the 2nd toe which creates a V shaped deformity at the MTP joint.
Bunions are more common in women than in men. Common causes of bunions include wearing narrow shoes and high heels. Certain medical conditions such as various neuromuscular conditions and inflammatory conditions (such as rheumatoid arthritis) can be risk factors that contribute to the development of a bunion. Bunions are also much more common in people who have a family history of bunions. The severity of the bunion deformity is not always directly related to the bunion symptoms. Sometimes a mild bunion can cause severe pain and sometimes a severe bunion deformity causes only mild discomfort. However, in general, as the foot deformity gets worse, the pain over the bunion also gets worse.
The good news is that there are many nonsurgical treatments that can help you manage the bunion pain.
Changing your shoes
Narrow or tight-fitting shoes will lead to pain over the bunion bump (called the medial eminence). High heels will also lead to more pressure over the joint of the big toe and will worsen the pain. The best shoes are wide shoes, more specifically, shoes with a wide toe box. The toe box is the front part of the shoe. If there is enough room for all the toes to fit in the front of the shoe, the bunion will not rub against the shoe as much. This will result in less pain.
Toe spacers
Toe spacers between the 1st and 2nd toe (also called the first webspace) can help bring the big toe toward the inside of the foot which takes pressure off the bony prominence. The spacers have not been shown to correct the deformity, they may help alleviate the pain associated with the deformity.
Bunion pads
Soft pads made specifically for bunions can be placed in between your foot and your shoe. This can help ease the pain over the bony bump of the bunion.
Shoe inserts
Many people with bunions have very low arches which results in more pressure being placed over the bunion. Good arch supports can help support the arch and take pressure over the bunion. Over the counter shoe inserts (also called orthotics) can be purchased at various shoe stores, doctor’s offices, or online. The inserts help alleviate many types of foot pain including bunion pain by distributing the pressure on the bottom of the foot more evenly. In cases where over the counter orthotics are not effective, or in severe foot deformities, custom or prescription orthotics are necessary.
Medications
Nonsteroidal anti-inflammatory drugs such as ibuprofen or Naproxen can help reduce your pain by decreasing inflammation. Topical anti-inflammatory medications such as Voltaren or diclofenac gel can be rubbed over the painful area.
Ice
Place an ice pack over the painful, swollen area. A tea towel or cloth should be placed between your skin and the ice to keep the ice from being too cold.
What about bunion splints?
Bunion splints are braces that pull the big toe away from the 2nd toe. The idea is to stretch the tight ligaments around the big toe joint. However, there is no evidence that they actually work in correcting the deformity. Unless the splint helps relieve your pain associated with the bunion (which can be done with the above treatments), I don’t recommend these splints to my patients.
When is it time to consider surgery?
When the pain from the bunion is interfering with your daily life and the pain is not relieved by conservative treatments, it is time to consider getting the deformity corrected with surgery. Also, if the deformity is severe enough it can push against the second toe and lead to the development of a hammer toe. Even if the bunion itself is not painful, as the hammer toe becomes worse, it can lead to pain under the 2nd metatarsal head (‘ball of the foot”) or over the top of the toe where it rubs against the foot of your shoe. In cases where a hammering of the smaller toes is starting to develop, it is reasonable to consider surgical correction.
The type of surgery is based on the severity of the deformity and presence or absence of other underlying conditions. The goal of surgery is to correct the deformity enough to provide long term pain relief and to prevent recurrence of the deformity.
In many cases the deformity is corrected by a combination of released tight soft tissue between the first toe and second toe and cutting the bone at the first metatarsal and shifting it toward the 2nd toe (called an osteotomy) and fixed it in its new position with screws. In severe cases, a small wedge of bone is removed from the proximal phalanx as well in order to realign the big toe in its correct position.
For large deformities with significant rotational deformity and/or very loose joint at the base of the great toe (called the first tarsometatarsal joint), the deformity is fixed by correcting the position of the first metatarsal into its normal position and then fusing this joint. This procedure is called a Lapidus procedure.
In some cases, severe arthritis or instability of the first MTP joint has developed. A reliable way to correct the bunion deformity is these cases is to fuse the great toe MTP joint into a corrected position.
Dr. Jeremy M Saller, MD. All rights reserved.
The content of this article including text, images, and graphics is for general informational purposes only. It is not intended to substitute for professional medical advice, including a medical diagnosis and treatment plan.
If you need medical evaluation and you live in South Carolina near Columbia, Irmo, Lexington, or the surrounding regions, you can book an appointment with Dr. Jeremy M Saller, MD at https://www.midorthoneuro.com/doc-saller.php or call 803-256-4107 to book an appointment.