What Ails You: Proper foot care can help prevent bunions

A bunion begins when the big toe is forced toward the other toes. In extreme cases, the big toe may actually creep underneath the second and even the third toe, pushing them up.

Bunions can result from wearing poorly fitting shoes, such as high heels with narrow, pointy toes, but I have friends with bunions who have never in their lives worn a pair a high heels. There may be a genetic connection since folks sporting bunions often have parents who had them as well. Although bunions are more common in women, they are not uncommon in men. Folks with flat or weak feet are particularly vulnerable to forming bunions.

A bunion forms when the joint at the base of the big toe becomes inflamed and, over time, enlarges. The joint gradually deforms so that the toe painfully points toward the other toes. A bony bump forms on the side of the joint at the base of the toe and can become quite painful, red and swollen. Sometimes a tough callous grows over the side of the toe.

An often overlooked cause of bunion is stiffness in the base of the toe. In order for you to walk normally, you must be able to extend the toe — point it upward — at least 60 degrees. When the joint becomes stiff, in order for you to walk normally, the body simply pushes the toe out of the way toward the other toes. When the problem is caught early enough, your physical therapist can help by restoring normal movement in the joint relieving the cause of the stress.

Although severe bunions will require surgical intervention to correct the deformity, there are many things you can do to help yourself before the bunion reaches that point. Make sure the toe boxes of your shoes are roomy enough that your toes have wiggle room. Although your shoes should be snug at the widest part of your foot, which is the same area we are talking about, they should not be tight. As the big toe lays over toward the other toes, a bump forms on the outside edge at the base of the big toe. This bump is vulnerable to friction as it rubs against the side of your shoe. Wearing a protective pad there may help to reduce the friction and with it the soreness. Wearing thick and well-cushioned socks can help. If you are developing a callous over the side of your toe, apply a moisturizing lotion before putting on your socks and shoes.

You can buy a toe separator, a jelly-like silicone insert that slips between your two first toes and keeps the big toe in better alignment. These toe separators are available in the Dr. Scholl’s section of most department stores and pharmacies.

When the joint is red and inflamed, use the anti-inflammatory measures we have talked about in other articles. Soak your foot in ice water. Take over-the-counter anti-inflammatory medications (aspirin, ibuprofen, naproxen sodium) that do not interfere with your other medications and are approved by your doctor. Stay off the foot as much as possible. Keep the foot elevated for a time in the evening before you go to bed to cope with swelling in the area and reduce the throbbing pain.

If your bunion is not responding to your home care routine, you need to see the doctor. He will want to take an x-ray to see the condition of the joint. He may prescribe a stronger anti-inflammatory medication. He may refer you to a physical therapist. The therapist will assess the movement in your foot to determine if mobilization and strengthening are in order. Supportive shoe inserts can help when falling arches are contributing to the stress on your joints and more substantial bracing can be ordered to correct the position of the toe.

As a last resort your doctor may recommend surgery. He may need to take out the swollen tissue which has collected around the joint because of chronic inflammation. He may need to straighten the joint by removing part of the bone or he may decide the joint should simply be fused. Fusing the joint presents problems of its own since, as I explained earlier, you must have motion at that joint in order to walk properly. Regardless of the procedure, you will need two to three months to recover from bunion surgery.

A bunion presents a permanent problem. If you notice that your big toe is drifting toward your other toes, whether it is painful or not, you need to take action. Consider obtaining a toe separator and make wearing it a habit. By being aware of the problem early, you can save yourself a lot of pain and perhaps an eventual surgery.

ABOUT THE WRITER:

Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com