What is that painful bump on the inside of my foot?
Foot bunions are prominences of bone that can develop on the inside of the foot just behind the great toe. Bunions occur when the first metatarsal bone starts to angle inward (away from the second metatarsal, the bone behind the second toe). Usually what then happens is the big toe starts to lean toward the second toe. Sometimes the big toe even bends under or over the top of the second toe.
Bunions usually become painful when closed shoes start to put pressure on the prominent area. As a result, bunion pain is more common in women because women are more likely to wear tight fitting shoes. With constant shoe pressure the bunion area will become increasingly red, inflamed and sensitive. It can worsen to the point that even light pressure on the bunion area will cause discomfort. Some people with bunions can’t even put on a closed shoe without pain.
Despite what you may see on advertisements and late night television, the only way to eliminate a bunion is with corrective surgery. There are no gadgets or tricks that will make the bone bump any smaller. Fortunately, as long as the bunion does not become too severe, new surgical techniques allow for shorter recovery time and less pain than in the past. Severe bunions of the foot will require a more invasive surgery that doesn’t allow for immediate walking. A cast and use of crutches will likely be necessary.
There are several options for bunion treatment that do not involve surgery and, in the early stages of the deformity, can help provide relief. The goal of these treatments is to either decrease the pain of the bunion or slow down its progression (or hopefully both!) In the long run, however, the bunion deformity is likely to gradually get worse no matter what you do.
The thing that is most likely to decrease your bunion pain is to wear better (and wider!) shoes. If your shoes are too narrow they will press on the bunion area and cause pain and inflammation. Also, shoes with greater support and stability for the arch help to decrease pressure on the bunion site and may help to slow the progression of the deformity.
Another conservative, non-surgical, option is to obtain custom foot orthotics from a podiatrist. By providing greater support for the arch and stabilizing the foot, orthotics are able to decrease the forces on your foot that make the bunion “lump” become bigger and make the big toe deviate to the side. Also, custom orthotics, when properly fabricated, can decrease the pressure on the bunion itself and relieve pain.
There are also many types of protective pads available at the pharmacy or from your podiatrist that can hold the big toe straighter and decrease shoe pressure on the bunion. You should avoid any type of medicated pads, which can damage the normal, healthy skin. However, the cushioned or “donut” type of pads can be helpful for those “special occasions” when you find yourself wearing tighter-fitting dress shoes.
The use of a device called a “bunion splint” can help to align and hold the big toe in place while you are sleeping or resting. Bunion splints help to keep the soft tissues on the side of the big toe from contracting and making it even more difficult to straighten the toe. Because there are so many different types of bunion splints, the safest thing to do is to have one dispensed and fitted by a podiatrist to ensure you get the proper splint for your particular deformity. Not all bunions are alike!
One other non-surgical treatment option for a bunion is to administer a cortisone injection to the painful area. Cortisone can temporarily relieve the pain of a foot bunion, but this should not be considered a routine treatment. However injections can be helpful in certain situations. For example, if you let your bunion pain get out of control and are unable to even put on a shoe, then an injection may provide help to relieve the acute symptoms. Another possibility is if you are planning on having bunion surgery, but need some temporary relief to get you by until the surgery.
Anyone with a bunion, even those who are not considering surgery, should have their condition evaluated by a podiatrist. The evaluation should include x-rays taken while you’re bearing weight (standing) on your feet. These x-rays can serve as a baseline and be compared with films a year or two later to see how fast your bunion is progressing.
Remember to be good to your feet, especially if you have a bunion (or two)! Get evaluated by an experienced podiatrist, have x-rays taken and most importantly, please don’t wear shoes that make your bunion even worse.
Your soles will thank you!