Yimeng Zhang from the Malta Medical Students Association says wearing shoes that fit properly reduces the risk of developing symptomatic bunions. It is best to avoid wearing pointed shoes or high heels for long periods of time.
A bunion, also known as a hallux abducto valgus deformity, is characterised by a large bump at the base of the big toe. Bunions form when the big toe pushes up against the other toes, forcing its joint in the opposite direction, away from the normal profile of the foot.
The big toe can sometimes even cross over or under the other toes. As pressure is applied to the base of the big toe, the tissues surrounding the joint may become swollen and tender. This causes an enlargement of the bone or tissue, which is the main source of the pain experienced. The bump itself is partly due to the swollen joint or a bony anomaly, with the majority caused by the tilting of the bone at the base of the toe, causing one end to stick out.
Studies have found that one in three senior adults has at least one bunion. They are typically twice as common in women and the likelihood increases with age.
There are a number of causes for bunions, one of the most common being the continuous use of inappropriate shoes. Bunions can also develop as a result of an inherited structural defect, stress on the foot, or a medical condition, such as arthritis.
Surgery, by an orthopaedic or a podiatric surgeon, may be necessary when experiencing difficulty with walking and daily activities or when nonsurgical treatment has not relieved bunion pain
Wearing properly fitted shoes reduces the risk of developing symptomatic bunions. It is best to avoid wearing pointed shoes or high heels for long periods of time. Shoes should be wide enough for toes not to be forced together with enough room for them to move. Shoes that are made of soft leather and are wide fitting are a good choice. When selecting shoes, it is worthwhile to have your feet measured properly – many people unknowingly wear shoes that are the wrong size.
If in doubt, your podiatrist can give you advice about suitable footwear. Wearing shoes that are too tight and do not fit properly is also likely to make an existing bunion worse.
Bunions may be treated conservatively with changes in footwear, medically prescribed insoles (orthotics), rest, ice and medication. These treatments address symptoms rather than correct the actual deformity. Various footwear such as gel toe spacers, bunion/toes separators, regulators, splints and cushions are easily accessible and have been proven effective for mild cases.
Surgery, by an orthopaedic or a podiatric surgeon, may be necessary when experiencing difficulty with walking and daily activities or when nonsurgical treatment has not relieved bunion pain. It can also be recommended if the bunion has rapidly worsened over the year.
Bunion surgery generally involves an incision in the big toe joint and the removal or realignment of soft tissue and bone in order to relieve pain and restore normal position to the joint. If the joint is severely deformed, it may be stabilised with tiny wires, stitches, screws, or plates, coupled with a local anaesthetic and a sedative during the procedure.
Although there are many different bunion surgeries for different effects, the age, health, lifestyle and activity level of the patient may also play a role in the choice of procedure.
The usual recovery period after bunion surgery varies from six weeks to six months, depending on the amount of soft tissue and bone affected.
Regular shoes can sometimes be worn after four to five weeks, but some procedures require wearing special shoes for eight weeks after surgery.
Complete healing may take as long as one year, but many activities can be resumed in six to eight weeks.
After surgery, the ability to walk and do other activities usually improves.
The big toe joint is generally less painful and, as a result, moves better. After the incision has healed, the toe may look more normal than before.
Variations among deformities and surgical techniques make it difficult to evaluate the success of bunion surgery.
Some studies suggest that 85 to 90 per cent of patients are satisfied with their results, but one review found that a third of patients were dissatisfied, even when pain and toe alignment had improved. This may have been due to unrealistic expectations – some patients mistakenly believe that after surgery, the big toe will be completely straight and the foot will fit into narrower shoes.
Some patients also expect faster relief from pain and swelling than the procedure entails. Surgery may also reduce the flexibility of the big toe joint, which is a concern for active people who require a lot of movement in the big toe.
Complication rates from various studies range from 10 to 55 per cent. The most common complication is recurrence of the bunion (in up to 16 per cent of cases).
This can happen when only the bony prominence is shaved off and the underlying deformity is not corrected.
Studies have found that one in three senior adults has at least one bunion. They are typically twice as common in women and the likelihood increases with age
Sometimes the cut bones do not reunite properly, which then requires additional surgery.
Other possible complications include irritation from the pins or screws used and excessive scarring or stiffness. Swelling after surgery usually eases within two months, but the joint may be stiff for several months.
It is essential to acknowledge that bunions may return after surgery, especially if wearing narrow or high-heeled shoes.
Although surgery may improve your foot’s appearance, those who make appearance their primary reason for surgery are generally disappointed with the results.
The decision to undergo surgery is not easy. Benefits, risk and expectations should be discussed with your doctor and podiatrist in order to make an informed decision.