Take the right steps to deal with bunion pain

Published: The Patriot-News

High heels can contribute to bunion pain.

Julie Rich had been battling a bunion since she was in middle school.

The 35-year-old Hampden Twp. woman recounts years of frustrating shopping trips to find shoes that she could tolerate and painful years of suffering with those she couldn’t.

“I kept wearing high heels; you know, sometimes fashion is important. But it got to the point where I couldn’t wear high heels anymore or any shoes at all, really,” said Rich, who, as a medical resident several years ago, finally elected to have surgery.

Rich isn’t alone in suffering with bunions. Statistics from the National Institutes of Health say almost 4.5 million people deal with them annually.

What exactly is a bunion?

“A bunion is a slow dislocation of the big toe joint,” said Dr. Helen Gold, podiatrist with Zlotoff, Gilfert, Gold & Associates in Hampden Twp. “The big toe is moving laterally toward the other toes and the metatarsal bone is moving away from the foot. The bump you see is actually the joint sticking out of the bone.”

Bunions are often thought of as being hereditary, but it’s really the foot structure that makes one prone to bunions that is hereditary, said Dr. Allan Grossman of the Harrisburg Foot and Ankle Center, with locations in Lower Paxton and Hampden townships.

The bunion is “a symptom of things like flat foot, abnormal foot structure, alignment or injury,” he said.

Certain shoes, particularly high-heeled, narrow or tight shoes and those with no support, such as flip-flops, can bring bunions on faster, podiatrists say. Both men and women can get bunions, but women tend to get them more because they won’t give up their fashionable heels.

Michelle Altland puts herself in that category. The 45-year-old Dillsburg woman said she wore heels constantly even after she started developing a bunion in her early 30s.

“I noticed my toe was starting to turn toward the other toes, but I didn’t do anything about it. At that age, I was still thinking I was invincible and assumed everything would be fine,” she said.

After she began working for a podiatrist, she got a foot X-ray and found out she had something called hallux ridgidus, which is decreased joint space in the big toe that causes pain and can contribute to a bunion, she said. She tried a cortisone shot and custom orthotics and finally gave up her heels — to no avail.

She had a successful bunionectomy several years ago and remains bunion free. “It took about three months after surgery until I realized, wow, I’m walking with no pain,” she said. “I wish now that I would’ve done it sooner.”

Doctors said they see bunions in patients of all ages, even those as young as 8 to 10 years old. Initial symptoms are often aches in the joint of the big toe when walking or standing. Other symptoms include the classic red bump on the side of the big toe, pain aggravated by pressure from shoes and the big toe turning toward the other toes.

“I advocate seeing a podiatrist as soon as you see symptoms because if you get help young enough, you can stop or slow down the deformity by doing strengthening exercises to build up the muscles. You can also wear an insert to hold the foot up to where it should be,” Grossman said.

On an initial visit, Grossman said he does a gait evaluation first to look for the mechanism that is causing the bunion and then look for ways to address it.

Before surgery, there are other things that people suffering with bunions can try.

“The most important thing is the type of shoe you wear,” Gold said. “The best type is a wide, smooth shoe with good arch support. Collapsing of the arch makes bunions happen faster.”

Flip-flops are about the worst type of footwear possible for people with bunions, she said. She also cautioned against shoes with a heel of more than two inches and shoes that are narrow in the front.

Patients can also try splints or pads, which will not correct the bunion but can ease the pain, or orthotics, which are custom-molded plates for the shoe that control the motion of the foot and prevent the metatarsal bone from moving away from the toes.

“If we see a bunion starting in a young person, we try orthotics right away to try to avoid surgery,” Gold said.

Of the hundreds of people they treat for this common foot problem, the minority opt for surgery, doctors said.

“Plenty of people live just fine with their bunions their entire life. However, if a bunion hurts so much that it is interfering with ability to do things or if it’s starting to push on the second toe and go under it, causing a hammer toe of the second toe, then we look at surgery,” Gold said.

There are about 100 kinds of bunionectomies that doctors perform, depending on what X-rays show about the structure of a person’s foot. The surgeries, which are usually outpatient, can involve breaking the metatarsal bone, removing the bump and realigning the soft tissue and joint. Sometimes a pin is inserted to hold the bone in place.

Rich began physical therapy before her surgery and continued it afterwards for a total of two to three months. “When you have a bunion, you adapt your walking to it so you need to readapt,” she said.

She was on crutches for three months after her surgery and took two weeks off work. “The surgery I had was very involved and intense, but in retrospect, it was worth it,” said Rich, who is still bunion free.

Living with bunions:

·       Wear comfortable shoes that conform to the shape of your foot.

·       Wear shoes with a wide and deep toe box.

·       Always fit the larger foot — caused by the bunion — and have your feet sized each time you purchase shoes.

·       Apply a commercial, non-medicated bunion pad around the bony prominence.

·       If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.

·       Avoid high-heeled shoes over 2 inches tall.

·       Seek professional podiatric evaluation and assistance with uncomfortable or noticeable bunions.

Source: American Podiatric Medical Association

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas anytime @702-878-2455 between Monday – Friday and we would be happy to set up an appointment for you.  Please visit our website @ www.FallCenter.com.   The Foot, Ankle & Lower Leg Center has Diagnostic imaging:  Digital X-Rays, Ultrasound or Advanced Imaging will be used to aid in the diagnosis.

Dr. Anthony Ricciardi at the Foot, Ankle & Lower Leg Center has completed training in endoscopic/minimally invasive surgery for chronic heel pain and nerve pain, foot and ankle joint replacement for restoring pain free motion, arthroscopic surgery, bunion surgery, fracture repair, flat foot correction, external fixation for complex deformities and extensive experience in peripheral nerve surgery including diabetic peripheral neuropathy and reconstructive surgery of previously failed foot surgical procedures.  In addition to his surgical training Dr. Ricciardi focuses on sports medicine of the foot and ankle through regenerative techniques using the patient’s own blood/platelets for healing chronic foot and ankle problems (pain) as a result of repetitive sport injuries.  This cutting edge technology enables patients to continue training with little or no down time.  Dr. Ricciardi continues to be active in teaching and training other podiatric surgeons on innovative surgical techniques in foot surgery.  Dr. Ricciardi is Board Certified by the American Board of Podiatric Surgery, a Fellow of the American College of Foot and Ankle Surgeons and Fellow of the Association of Extremity Nerve Surgeons.  Dr. Ricciardi’s vision is to bring each patient the most current state of the Art Technology and personalized treatment options to meet their Foot and Ankle needs (from conservative care to surgical options).  Dr. Ricciardi believes in quality service and puts his patients first!