Dr. Pradeep Moonot
If the joint that connects your big toe to your foot has a sore bump, then chances are you may have a bunion, a common deformity. Largely, Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons in your feet.
This imbalance in pressure makes your big toe joint unstable, eventually molding the parts of the joint into a hard knob that juts out beyond the normal shape of your foot.
While tight, high-heeled or too-narrow shoes could be one of the cause for bunions, inherited foot type, foot injuries or any deformity present during the birth are also accountable for the foot deformity.
Surprisingly, bunions may also be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis.
How bunion affects
With a bunion, the base of your big toe (metatarsophalangeal joint) gets larger and sticks out and results in the skin over it may become red and tender. Wearing any type of shoe may be painful and this joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk.
Normally, your big toe may angle toward your second toe, or even move all the way under it to an extent that the skin on the bottom of your foot may become thicker and painful. Sometimes an advanced bunion may make your foot look grotesque. And if it gets too severe, it may be difficult to walk. Therefore, your pain may become chronic and you may develop arthritis.
Prevention and cure
Though bunions are curable, at times they tend to become permanent unless surgically treated. Your podiatrist or a Foot and Ankle Specialist can identify a bunion by examining your foot.
Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling.
In case conservative treatments like padding your shoe, medication, changing your shoe type, etc, doesn't provide relief, you may need surgery. The goal of bunion surgery is to relieve discomfort by returning your toe to the correct position. There are a number of surgical procedures for bunions, and no one technique is best for every situation.
Surgery may involve removal of the swollen tissue from around your big toe joint, straightening your big toe by removing part of the bone, realigning the long bone between the back part of your foot and your big toe, to straighten out the abnormal angle in your big toe joint, etc.
In case of bunion deformity, the surgery helps to produce a narrow foot and the straighter big toe. The toe area needs little extra care much like in any other surgery. "The capsule repair must be protected with the specialised dressing for 2 weeks. The surgery allows to give a 3D cut for precision.
It's possible you may be able to walk on your foot immediately after a bunion procedure. However, full recovery can take weeks to months. After the surgery, usually doctors advise post-operative shoes for almost 6 weeks until the foot is completely healed.
The post-operative shoe allows for heel weight bearing (walking) immediately, though this is often too uncomfortable for the first week.
Otherwise too, the foot must be elevated (above the level of the pelvis) for 90% of the time for the first 10 days. This helps to reduce swelling and the risk of infection, and helps in healing of the wound. And to prevent a recurrence, you'll need to wear proper shoes after recovery.
Surgery isn't recommended unless a bunion causes you frequent pain or interferes with your daily activities. But in any case, if you suspect a bunion on your feet, don't delay and see a Foot and Ankle Specialist or a Podiatrist.
Tips to help prevent bunions
Be sure your shoes don't cramp or irritate your toes.
Choose shoes with a wide toe box — there should be space between the tip of your longest toe and the end of the shoe.
Your shoes should conform to the shape of your feet without squeezing or pressing any part of your foot.
Avoid pointy-toed shoes.
Author is Orthopaedic Surgeon & Podiatrist, Nanavati Hospital, Mumbai