Is physical therapy useful for bunions?

Physical therapy includes wearing splints, ultrasound or whirlpool baths can help soothe the pain and assist in ambulation. There are a variety of splints available and they do help relieve pain. Often shoe inserts can help control abnormal movement of the foot. Shoe inserts can be acquired with or without a prescription. The prescription shoe inserts are a rip-off and are no more effective than the non prescription variety.

To prevent recurrences one should wear proper shoes and avoid high heels. The best advice for patients with bunions is to rest, limit activity, which worsens the symptoms, and obtain proper shoe wear.

What is role of surgery for bunions?

When all the above non-surgical treatments fail, surgery may be the only other alternative. Surgery involves removal of the swollen tissues and realigning the toe.

However, surgery is not always successful and bunions can recur. Recovery after surgery can take a few weeks and the course is also marked by difficulty in ambulation. Moreover, surgery requires time off from work, there is significant pain afterwards and the results are not guaranteed. More often than not, you will be worse off than what you started off. 

Finally, a number of orthopedic surgeons who do bunionectomy have poor technical skills. If you do decide to go for surgery, choose your surgeon well. There are no refunds for cock-ups, which are common in bone surgery.

How are bunions treated?

The earlier one seeks treatment, the less the chance of developing joint deformity. The treatment of bunions involves:

Rest and changes of shoes. Wearing wide shoes or sandals may help relieve pressure on the toe joint. There are many shoes, which are specially designed for bunions. One can even pad shoes around the toes to relieve pain and eliminate stress

Wear shoes that are comfortable and have plenty of toe space

The pain of a bunion is easily controlled with over the counter pain medications. Often some people find that applying a cold ice pack can relieve the swelling and joint pain.

In the majority of cases, conservative measures can help relieve the symptoms. However, a few percent of affected individuals find no relief from the above measures and may require alteration in foot care.

Injection of corticosteroids is widely done but only offers temporary relief. Less than 20% of patients with bunions benefit from steroid injections

How is the diagnosis of bunion made?

The diagnosis of a bunion is straightforward. The physical exam is almost always diagnostic but most physicians will obtain x-rays to confirm integrity of the joint and presence of any underlying condition like arthritis or gout. Prior to any surgery, x-rays are essential.

What are symptoms of a bunion?

While some bunions may not cause symptoms, the majority of individuals will complain of pain on walking or while wearing tight shoes. Once the pain starts in the joint, it will always progress if the shoes are not altered.

Associated with pain is the presence of toe swelling, redness and abnormal alignment of the joint.

Bunions are also very unattractive and limit the type of shoe wear

When a bunion is long standing, it may result in formation of corns and calluses at the side of the big toe.

What causes a bunion?

Bunions are common in women and this is most likely associated with the wearing of tight fitting shoes, especially high heel shoes with narrow toes. Overall, bunions are more common in people who wear shoes compared to those who are barefoot. There does appear to be a genetic link that predisposes one to bunion formation. 

Other risk factors that may contribute to bunion formation include abnormal joint anatomy, nerve injury, rheumatoid arthritis or some type of traumatic injury to the foot; bunions are also far more common in dancers and sports athletes who wear tight shoes. Individuals with flat feet and arthritis also have a tendency to develop bunions.