What is a bunion?
A bunion is a swollen and deformed big toe. It is a common problem which is painful but very rarely dangerous. The most frequent cause is the toe slowly dislocating – but it can simply be caused by arthritis.
Who get bunions?
Bunions are about twice more common in females than males; typically they are seen in families where generations of women have the problem. Four percent of non-shoe wearing females and just under 2 percent of males will generally have bunions with these numbers increasing to 48 and 16 percent in those who wear shoes.
In most bunions, once your foot starts to change shape it will only continue to get worse. The joint falls out of position and once this happens momentum is nearly impossible to stop. Progression can be very slow or sometimes surprisingly fast. Your pain is initially driven by tearing of the ligaments, then by jamming of the joint on the shoe and latter still by arthritis of the joint. Often the small toes will start to change too and these can cause a lot of trouble.
What can be done?
Your treatment most often starts with finding a show that fits the bump. Pick a shoe with a soft “vamp” and where the stitching doesn’t rub. Avoiding high heels might help lessen pain in the small toes and ball of the foot. Insoles are often hard to fit but can help here too. The trouble with insoles is that like pads, they will only stop pressure and rubbing; not deal with the underlying cause.
Why does it get worse?
Progression is driven by unbalanced muscle pull with a weak joint. Because the muscle pulls hard with every step, it is pretty much impossible to stop things getting worse without surgery once the toe position really starts to move.
What does the surgery usually means?
There are very many different surgeries for bunions; the choice of surgery will depend on how big it is and how much arthritis is in the joint. Better surgeries are those that rebuild a normal joint giving good position, shoe fit and movement. It involves cutting the bones to put them in a good position without damaging the cartilage and then balancing strength at the joint (moving tendons or muscles, tightening ligament so that pull is even).
What is the surgery like?
It is done in the hospital but can be done either as an inpatient or as a day surgery. Usually, you can walk on the foot on the day of the surgery but for the first week or two, most of your time is spent in bed to let the skin heal. After that, activity increases although the bones will not solidify for around two months and be really sound by four months.
If the joint is very arthritic then the fall-back option is to fuse it – this is counter-intuitively successful surgery but is confined for those whose toes are stiff and very painful. It leaves a very high level of activity but will stop you from wearing high heeled shoes.
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