If you look down and notice a bump on the inside of your foot (or feet), it could very well be a bunion deformity, also known as hallux valgus.
Bunions are a progressive deformity, explains podiatrist Austin Mishko, DPM, of St. Luke’s Podiatry.
“In layman’s terms, there is a bump on the inner part of the foot just in front of the big toe,” he says.
The big toe begins pushing toward the lesser toes, like the second toe.
“Once that happens,” says Dr. Mishko, “all of the muscles get messed up, and the tendons pull on the big toe, which makes it worse.”
Although bunions may not be fun to look at, Dr. Mishko says they’re not actually a problem unless they’re causing you pain.
Who Can Get a Bunion?
Bunions are more common in women, according to Dr. Mishko. “This might be because women’s shoes tend to be tighter in the front which constricts the foot,” he says. “High heels might also contribute to bunion development.” But whether women are more biologically prone to developing a bunion isn’t clear. The National Institute of Health (NIH) says women have weaker connective tissue, which could be related.
Bunions tend to develop in older adults. According to NIH it’s thought one out of three people over the age of 65 has a bunion “to some degree.”
Often, bunion development is due to family history, Dr. Mishko says, noting that 70 percent of the time that may be the reason.
Bunions can occur in children, but when that happens, there’s a 94 percent chance that it’s related to family history, says the podiatrist.
People who have laxity in their joints—those who might be “double-jointed,” have Down syndrome, or Ehlers-Danlos syndrome—might be more prone to bunions.
“If the joints are loose, the ligaments are lax…and that can allow bunions to form more easily,” Dr. Mishko explains.
What Treatments Are Available for Bunions?
The only way to reverse a bunion is through surgery, Dr. Mishko explains. He emphasizes the fact that if a bunion is not painful there isn’t any reason for intervention.
“If people come in [to see me] because they don’t like how their foot looks, if they think, ‘My bunion is ugly,’ that’s not a reason to treat that,” he says. “Every surgery has a risk, and we certainly don’t want to put someone at risk just because of how [the foot] looks.”
When there is pain, whether that’s on the bunion itself or on a lesser toe, like the second toe, that’s when surgery might be worth considering. Although there are more than 100 procedures intended to treat bunions, these are the most common surgical interventions, and those that Dr. Mishko performs:
Dr. Mishko explains that this is a tried-and-true procedure and has been available since the 1970s. The doctor will make an incision over the big toe joint, and the bone is cut in a chevron shape. The bone is then shifted to correct the form. Then the bone is secured with screws. The downside, he says, is it can result in stiffness, and there is a 25 to 30 percent recurrence rate.
This procedure is done at the midfoot, to address the rotation of the first metatarsal. The doctor will remove a piece of the bone and then shift the remaining bone into a corrected position, fusing it together with plates and screws. The recurrence rate is less than 5 percent, but there is a much larger incision than the chevron procedure, Dr. Mishko says. That means the post-operative recovery can be more difficult, staying off the foot for at least two weeks, and resuming walking in normal footwear six to eight weeks later.
Minimally invasive bunionectomy
This newer procedure, in its current form, is just 10 years old so there isn’t long-term data available on success rate, Dr. Mishko says. In this procedure, the doctor will cut across the metatarsal bone, an incision that’s less than 1 centimeter long. Through X-ray guidance, the doctor will push the bone over and secure it with screws. “There is less joint stiffness in the big toe because you’re not invading the joint capsule,” Dr. Mishko says. “Plus, it’s more cosmetically favorable thanks to the tiny incision.”
These procedures may have to be performed in conjunction with an akin osteotomy, which is a small wedge taken out of the part of the big toe (the proximal phalanx) and fixated with a screw, Dr. Mishko explains. If needed, this is often done for additional correction.
When considering surgery, Dr. Mishko wants his patients to think about how their bunion affects their daily lives and what it would look like to be off their feet for weeks.
“Patients have lives, work, family,” he says. “They may not be able to deal with the post-op course, so come back when the pain is so severe you can’t deal with it.”
The prognosis for bunion treatments is generally very good, says Dr. Mishko. He sees success rates in pain score, lifestyle scoring, as well as low complication rates.
In the meantime, if there is no pain, Dr. Mishko says there are lifestyle interventions people can take to slow the progression of the bunion.
“Conservative treatments are not meant to correct the deformity,” he says. “Nothing but surgery can reverse it, but we can help control it.”
He recommends wearing shoes with wide toe boxes or stretchy upper materials to allow the foot to splay out. There are silicone pads that go between the first and second toes to hold the big toe straighter. He recommends these pads in older patients who are not surgical candidates.
A hammertoe is a common secondary deformity in those with bunions and can be treated with toe pads as well.
Dr. Mishko also recommends people speak with their doctors about orthotics to help build up the arch. These are available over the counter or can be custom made.
If there is pain or inflammation, an over-the-counter non-steroidal anti-inflammatory medication, or NSAID, can help alleviate the pain and swelling. In some cases, people might benefit from a steroid injection.
What Should I Ask My Doctor?
If you’re seeing a podiatrist for a bunion, Dr. Mishko reiterates the importance of asking for conservative treatments if there is no pain.
“If your doctor is trying to push for surgery and the cons aren’t discussed, that’s a red flag,” he says. “Ask about the recovery time and how that will affect your lifestyle.”