Bunions : “The Case of the Long Island Bumpy Foot”
It was a hot summer day many years ago when I first encountered a bunion . This was many years before I studied to become a podiatrist, on Long Island. Sitting on the boardwalk I happened to look down at the feet of the person sitting next to me. For a young person, her feet looked like those of an 80 year old! Her big toes were hitch-hiking to the right and the left under her second toes which were bent and crooked. Later I learned that these were called hammertoes, but that is story for another time.
The Bunion Discovery
It was many years later that I studied in depth about this deformity Hallux Abducto Valgus or in laymen’s terms, a bunion deformity. A bunion is a deformity of both the bone and ligaments and tendons around the big toe joint otherwise known as the first metatarsophalangeal joint. It has several causes including neuromuscular disorders, arthritis, and gout but the most common cause is hereditary. It is rarely a disorder that occurs at birth but rather a gradual, slowly progressing condition. Improper shoegear including high heeled shoes or pointed shoes can worsen an existing condition or speed the development of a bunion in those already predisposed by their heredity.
The first metatarsal bone slowly begins to deviate toward the other foot while the big toe bones (phalanges) get pushed and pulled in the opposite direction. This causes the bump to appear and grow bigger over time. As the bone deviates, it causes nerve irritation and pain while wearing shoes and over time can become an arthritic joint when left untreated.
What are the options to treat bunions? It is hard to tell women, especially women from my town ( Great Neck, Long Island, N.Y.) that they can no longer wear high-heeled narrow shoes. If a patient is not a surgical candidate, treatment options include padding of the area, cortisone injections to relieve nerve irritation, changes in shoegear, and orthotics. But a bunion deformity is a bone deformity and in order to permanently correct the problem, surgical intervention is required. A podiatrist will take an x-ray when considering a treatment plan to determine if the joint is arthritic and the severity of the bone deformity. There are many types of bunion surgical procedures. Factors that determine what type of bunion surgery is best include the patient’s age, progression of deformity, any damage to the joint surfaces, patient compliance, level of pain, severity of the deformity and most importantly the bunion patient’s expectations.
Depending on the severity of the deformity, the recovery period will vary. Certain procedures allow the bunion surgery patient to walk on the foot the same day with a surgical shoe and others require the patient to be non-ambulatory on the affected side for up to two months. Your podiatrist should review the x-rays with you and discuss all of the risks and benefits of the surgical procedure that is chosen.
It is my opinion that a young person should not wait until the deformity progresses to the point where regular shoes become uncomfortable. Early intervention can lead to a slowing of the deformity progression or if bunion surgery is necessary it is better to do it when the deformity is in its earlier stages. The good news is that the “bumpy foot” is treatable and if addressed early enough can allow the person to fit into the shoe of their choice, and continue to enjoy a pain free active lifestyle.Our office is always available to answer questions about all types of foot health including surgical options for all foot deformities. Feel free to call us for consultation. Visit our website at greatneckfamilyfootcare.com