By Dr Paul Stasko, DPM

Dear Doctor,
I have a bump on the inside of my foot that I have been told is a Bunion. My mother and grandmother both had bunions. Recently my foot has become more painful and I feel like the bump is getting larger. I do well in summertime with open toe shoes, but I am concerned about wearing close toe shoes, what should I do?

Dear Reader,
Thank you very much for your question. This is a very common problem that we see as Podiatrists that treat all different foot and ankle pathology. Bunions can be hereditary, and the foot type that lends itself to bunion formation can be a main factor in the formation of the bunion. They can be due to a traumatic event as well. A Bunion is a bump that forms on the inside of the foot near the great toe joint. This is a progression of the 1st metatarsal into a more abnormal position, causing the great toe to point towards the outside (lateral) aspect of the foot. This can cause overlapping of the 1st and 2nd toes, calluses, abnormal range of motion and function of the great toe, bony prominence, and pain. There is a large range of treatment for bunions depending on your age, activity level, and pain threshold.

The initial treatment for bunions starts from a conservative, non surgical standpoint. I tell my patients to start by accommodating shoe gear, meaning wearing a wider, more supportive shoe to avoid pressure on the bunion itself. Open sandals will provide relief, which is part of what you were telling me in the initial question. Along with more comfortable shoes, splinting of the bunion can be performed, as well as padding, toe spacers, felt padding, and activity modification. In a patient with painful bunions, these can be a good start to treatment, and if effective, can be longer term treatments to provide relief. If a patient is not a surgical candidate, that these accommodative treatments can be a more long term resolution to the problem.

If conservative treatments fail and the patient is a good surgical candidate, than surgery can be performed on the bunion. There are numerous different types of bunion surgeries that can be done to treat the bunion and relieve pain. We only do surgery on bunions of there is pain and or dysfunction. The major categories of bunion surgery can be divided into procedures that remove the bump itself (ostectomy), or cut the bone to change the bunion position (osteotomy), or a procedure to fuse a joint in a better position and take away from the bunion (arthrodesis). These procedures are different for each patient and are tailored to the individual. Factors that determine the procedure include age, activity level, severity of the bunion, arthritis, function of the foot, patients' healing potential and allowable healing time.
In conclusion, having the bunion evaluated by a Podiatrist/Foot and Ankle Surgeon will be able to get you going in the right direction with treatment. Appropriate care can be started at the time of the appointment and improvement can be monitored. Feel free to give my office a call anytime to set up an appointment and keep you moving on your feet! Thank you very much for your question.

Sincerely,
Dr. Paul Stasko, DPM