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The tendency to develop bunions (hallux valgus) is at least partly hereditary, but the degree to which the malformation progresses depends on the kind of stress the foot undergoes while walking. Appropriate footwear can slow the development of bunions, just as inappropriate footwear can hasten it.
What is a bunion?
When the big toe (hallux) takes a "valgus" position (a deformity in which the body part is turned away from the midline of the body to an abnormal degree), the outer joint (metatarsalphalangeal joint) of the big toe is dislocated, forcing the first metatarsal bone--one of the bones that form the arch of the foot--out of alignment. A bunion looks like a big lump on the side of the foot, at the joint of the big toe. The big toe itself turns inward toward the other toes, instead of pointing straight ahead as it should. The joint often becomes painfully inflamed, and in severe cases, the misalignment of the big toe can even push the other toes completely out of alignment, so that they pile up on top of each other.
Why do women get bunions more often than men do?
Women's shoes often emphasize style over comfort. Narrow toes, high heels, and inadequate arch support--all of which are typical of women's shoes--are major factors in the rapid development of bunions. Even shoes that are not particularly stylish are likely to promote damage if they don't provide room for the toes or adequate arch support.
How can bunions be treated?
In less severe cases, the sufferer can use massage therapy, hot or cold compresses, and non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin, acetaminophen, ibuprofen, or naproxen, to relieve pain and inflammation.
Simply selecting appropriate footwear can help to relieve symptoms. Shoes should be boxy at the toe, to provide ample room and to avoid further aggravating an already swollen and painful joint. Good arch support is also important, because the bones of the arch are vulnerable to malformation as the bunion develops. Low heels, which are always better for the feet, are essential in treating bunions, because high heels put the entire weight of the body on the balls of the feet, the very part of the foot that must not be stressed if bunions are to be avoided or treated.
It is also possible to purchase over-the-counter toe pads to wear inside the shoe for temporary realignment of the big toe. Padded insoles can also enhance the shoe's arch support.
But if the bunion is severe enough, and such measures do not provide relief or prevent the condition from progressing, it may be necessary to consider surgery. Bunion surgery is performed on an out-patient basis. One approach is simply to remove a portion of the protruding bone. Another technique is to fracture and reposition the misaligned bone. In older patients, an arthritic joint may need to be replaced with a plastic one.
After surgery, a special walking cast or half-shoe is worn to permit walking, but it will be weeks, or even months, before the foot is completely healed. Obviously the best course is to prevent the need for such drastic measures by choosing only comfortable, wide-toed shoes with good arch support in the first place.
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