The Three-Stage Process of Dealing With Bunions and Bunion Pain
Bunions are bony outgrowths that form at the base of the big toe. Patients with bunions are genetically predisposed to have them, and bunions may be exasperated by poor shoe gear. Once formed, bunions don’t go away without surgery, but most patients can manage their bunions and the associated pain without resorting to surgery. In fact, bunion treatment usually follows a three-stage process. Some patients stay in stage one of this process forever, while others may eventually move on to stage two or three.
Stage One: At-Home ManagementIf you have bunions that only cause you pain from time to time, they can generally be managed with these simple, at-home treatments. Even those with more severe bunion pain should start off by trying these treatments before resorting to more aggressive measures. At this stage, your goal is to minimize bunion pain to the point that it no longer interferes with your lifestyle. These treatments can also help prevent bunions from worsening without causing any worrying side effects.
Stage-One Treatment OptionsFor many patients, wearing heels or shoes with too narrow a toe box may contribute to bunion formation. Purchase shoes with a wider toe box and with low heels to prevent bunions from worsening. Wider shoes also help alleviate pain since they don’t press so firmly on the bunion. Purchase moleskin pads at the drugstore and stick them to your bunions in the morning before putting on your shoes. The pads prevent the shoes from rubbing on the bunion and causing blisters. Soak your feet in a warm bath at the end of the day to increase circulation and ease bunion pain. Adding some Epsom salts to the water may help. Keep your weight within the healthy range for your height to decrease the amount of pressure on your feet. Less pressure means less bunion pain.
Stage 2: In-Office, Non-Surgical TreatmentsIf your bunion pain is still interfering with your daily life even though you’ve been using the treatments recommended in stage one, then these more aggressive, yet non-surgical treatments may help. These treatments are intended to ease bunion pain to the point that you can walk comfortably and enjoy other activities normally. They will not make your bunions to go away, but the treatments may keep them from getting worse. They may also prevent more serious complications like bursitis (swelling of the tendons in your foot) and metatarsalgia (inflammation in the ball of your foot.)
Stage-Two Treatment OptionsYour podiatrist may design a custom orthotic device or splint for you to wear on your foot. Depending on your needs, this device may sit inside your shoe, or you may put it onto your foot before pulling your shoe on. It is meant to prevent your foot’s bone structure from changing any further. Cortisone is a steroid that helps prevent inflammation. Before recommending surgery, your podiatrist may inject cortisone into the base of your big toe. This should reduce inflammation in the area, helping ease your pain and make walking more comfortable.
Stage 3: Surgical CorrectionIf you have tried all of the stage two treatments and are still struggling to live a normal, pain-free life because of your bunions, your podiatrist may recommend surgery. Indications that you need surgery include the following:
- Your big toe has begun to cross over your other toes.
- Your big toe is chronically inflamed. The inflammation does not subside with rest or other treatments.
- You experience pain and difficulty walking regardless of footwear style.
Stage-Three Surgical TreatmentsYour surgeon will devise the best surgical approach based on your unique foot anatomy and the severity of your bunions. One or more of these approaches may be used:
- In an osteotomy, the bones in your big toe are cut and realigned before being fixed in place with pins or screws. Sometimes a segment of bone must be removed to straighten the toe.
- In an exostectomy, the bump is removed from the bone that forms your big toe. This procedure is usually combined with an osteotomy.
- In resection arthroplasty, the damaged tissue in your big toe joint is removed, creating an empty space between the bones. This space becomes a flexible “joint.”