What’s the best way to deal with bunions? Experts share ways to ease pain and when to consider surgery

What’s the best way to deal with bunions? Experts share ways to ease pain and when to consider surgery Foot specialists recommend shoes with ample toe space and softer materials to ease bunion discomfort. Properly fitted footwear can help reduce pressure and friction around the affected joint. Kicking off your shoes at the end of a long day can be a relief – especially if you’ve developed bunions. A bunion is a bony bump that forms at the base of your big toe. As your toe angles toward the others on your foot, the bone at the bottom of the joint moves away from them, making your foot wider. Bunions can feel tender, sore or sharply painful and may make it difficult to walk or find shoes that fit without rubbing on them. Although bunions might seem like a minor problem, they can prevent people from exercising or doing their jobs comfortably, said Dr Kelly Hynes, chief of the foot and ankle service at Washington University School of Medicine in St Louis. “Bunions usually get worse as time goes by,” said Robert Lee, chief of podiatric foot and ankle surgery at UCLA Santa Monica Medical Center, but they don’t always get bad enough to require an operation. We asked experts about how to manage the discomfort and when to consider surgery. WHAT CAUSES BUNIONS? Whether you develop bunions largely depends on your genes, Lee said. While the bump isn’t there when you’re born, “you’re actually inheriting a foot type that’s prone to forming the bunion,” he said. People with flat feet or especially flexible joints may be more likely to develop bunions, said Dr Dane Wukich, an orthopaedic foot and ankle surgeon in Pittsburgh. Having arthritis or a previous foot injury can also increase your risk. Bunions are more commonly reported in women than in men. This may be because women are more likely to have joints that are hypermobile, or highly flexible, which can make them more susceptible to developing bunions, Dr Hynes said. Women’s shoes also may be more constrictive and pull toes inward, which can cause friction and pressure on bunions that typically make them more painful, Lee said. But researchers aren’t sure whether footwear alone can cause bunions. TREATING PAIN You can’t reverse a bunion once it’s formed, the experts said, but there are ways to manage the pain. Dr Wukich recommended looking for shoes that have ample space for your toes but are still snug in the heel. Shoes with laces can help keep your foot in place. Lee said footwear that uses softer materials like mesh around the toe area can be more forgiving on bunions than stiffer materials like leather. Dr Hynes said, “The main thing is finding a shoe that fits your foot and not making your foot fit the shoe.” Hayley Schanback, a physical therapist at Mount Sinai Health System in New York City, said strengthening the muscles that stabilise the arches of your feet – such as by practising moving each toe independently, or by doming and collapsing your arches – can reduce pain. Some small studies have suggested that using a silicone toe spacer, which separates the toes, can reduce pain. But “you can’t expect that bump on the foot to change,” Schanback said. At best, Dr Lee said, you may be able to slow its progression, though not all experts agree that’s possible. Research suggests that shoe inserts that provide arch support and splints that are meant to correct foot alignment cannot cure bunions, but they may reduce discomfort. In the short term, over-the-counter pain relievers like ibuprofen and acetaminophen can also provide relief. Though steroid injections can temporarily reduce inflammation and pain, Lee said, they’re not long-term solutions. WHEN SURGERY MAY BE THE RIGHT CHOICE If these strategies make your bunion feel better, you may not need surgery – even if your foot looks significantly misaligned. “We generally don’t operate on people who don’t have painful bunions,” Dr Wukich said. Surgery can lead to scarring, swelling and pain, and the bunion may come back, he said, so doctors typically recommend exhausting all conservative options before surgery. It might be the right option if your big toe is causing a hammertoe, in which the second toe buckles in the middle, since that toe can then dislocate, Dr Lee said. If your pain is getting worse or is affecting your daily routine, the experts said you should consider seeing a podiatric surgeon or orthopaedic surgeon who specialises in the foot and ankle and has experience performing bunion surgeries. Dr Lee said that compared with a few decades ago, surgeries now involve smaller incisions and cause fewer complications. While surgery still often requires months of recovery, he said, it “can really improve quality of life” for those in significant pain. By Allessandra DiCorato © The New York Times Company The article originally appeared in The New York Times.