Our feet take a beating, whether we're squeezing them into narrow high-heeled shoes or merely walking long distances. But we don't give them much thought until wear and tear take their toll. One of the most common foot problems is a bunion, a large bony bump that appears on the side of the big toe. Before you talk about it with your doctor, we'll walk you through some facts.
1. Improper footwear is one of the main causes of bunions.
Shoes that are tight, narrow or have pointy toes, all of which constrict the feet, or shoes with high heels are the footwear culprits, says Dr. Mark Glazebrook, an assistant professor of orthopedic surgery at Dalhousie University in Halifax. In addition to poor footwear, genetics is a common cause of bunions: people can inherit foot shapes that make them more likely to develop bunions, and wearing ill-fitting shoes can make the deformity worse. Because of the footwear factor, women tend to be more prone to developing bunions than men.
2. Many bunions are painful.
Pain from a bunion, which can range from mild to severe, "is most often associated with underlying arthritis or the degree of deformity," says Glazebrook, who adds that improper footwear will often intensify the pain. Small painful bunions, called bunionettes, can also appear at the base of the little toes. If you have a visible bump, persistent pain or limited movement in your big toe, see your doctor. The earlier you start treating a bunion, the lower your risk of developing serious joint deformities.
3. Another symptom is the angling of your big toe in toward your second toe.
The pressure from your big toe may also force your second toe out of alignment, sometimes causing it to overlap your third toe. You can develop a bunion at any age, from childhood on. Bunions are permanent and, left untreated, will usually get worse over time. A bunion can, however, remain a bony bump that never progresses into a deformity.
Page 1 of 24. Bunion-removal surgery should be considered a last resort.
If you have a bunion your doctor may recommend orthotics. But they don't work for everyone. If orthotics won't resolve your problem, your family doctor may refer you to an orthopedic surgeon for an assessment. The surgeon may recommend bunion-removal surgery, one of the most frequent outpatient procedures in Canada.
No one surgery is best for every bunion problem. There are several types of bunion-removal surgeries, ranging from simple bunionectomies (cutting off the bony bump) to realignment procedures including osteotomy, a combination of bone cutting and realigning.
Post-surgery recovery time typically lasts about six weeks. During this time, in order to promote proper healing, the patient must not perform any vigorous exercise. Surgery should be performed only by a health-care professional with training in orthopedic surgical procedures.
Bunion surgery, like most surgeries, is not without risk, and even after surgery, you may still have pain or develop a new bunion. Before you have a bunion removed, consider trying other, more conservative treatments.
Alternatives to surgery
Before considering surgery, try these options to get relief.
• Buy wide, comfortable shoes. Avoid shoes with pointy toes or high heels; they only put pressure on the affected joint.
• Consider getting custom-made orthotics (shoe inserts); in some cases they may help resolve structural foot abnormalities. Orthotics fit into most types of footwear that have removable insoles. (You can't fit an orthotic over a shoe's existing insole, since it will push the foot too high up in the shoe and throw off alignment.) Your family doctor can refer you to a certified pedorthist, who will assess your foot then design, make and fit a pair of orthotics for you. Some health-insurance plans cover a portion of the cost, which ranges from $350 to $500 per pair.
• To relieve pain and reduce swelling, take an over-the-counter anti-inflammatory pain medication such as ibuprofen or acetylsalicylic acid (ASA). Ice the swollen joint for 10 minutes at a time, once or twice an hour as needed. For more information, visit the Canadian Orthopaedic Association's website or call (514) 874-9003.
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