Bunions

What is a bunion?

Hallux valgus may sound like a curse from Harry Potter, but it’s the medical term for a bunion, a bony growth where the big toe joins the foot. At best a bunion is an unsightly bump which can get a bit red and sore. If it gets big enough it  limits the type of shoes you can wear, and sometimes a painful sac of fluid known as a bursa develops around it. But left untreated, a bunion really can become a curse if it starts to push the big toe towards the smaller ones, causing more problems such as hammer toes, or problems in the spine and legs.

What causes bunions?

Bunions result from the long bone in the foot (metatarsal) and the big-toe bone becoming misaligned. The causes are likely to be a combination of genetics, wearing ill-fitting shoes, and the way that we walk or run. Arthritis sufferers are also prone to bunions.

How can I prevent them?

If you are genetically at risk, not a lot. But shoes that are too narrow, too tight (even ballet flats) or have very high heels that force your toes down into the pointed end are asking for trouble. Aim for a 1cm gap between your toes and the end of your shoes. This doesn’t mean wearing frumpy flatties - the Society of Podiatrists and Chiropodists recommends sticking to 4cm heels for everyday wear, and wearing different types of shoe to vary the position of your foot. Gladiator styles can help because the straps stop your foot pushing down into the point of the shoe, ditto Mary Janes (sorry but for beautiful feet they need to have a strap), and flat, wide-fitting brogues are a no-brainer. Alternatively, in summer you can wear flip-flops to keep the space between your big and second toe as wide as possible.

If you have children it’s vital to make sure that their feet are measured for properly fitting shoes to nip any potential problems in the bud.

Keeping your feet and lower legs supple and strong is important too - that’s how A-list celebs get away with wearing killer heels: they all work-out like crazy. Exercises like trying to widen the space between your big toe and the second one with your foot flat on the floor, a few times a day can help, as can calf stretches.

If you are devoted to any exercise that involves high impact for your feet, it might be worth checking that your gait and shoes are correct with a specialist shop such as Runners Need, as poor styles can cause irreparable bunion-related problems that will consign your trainers to the back of the cupboard for ever.

How to treat a bunion

 

You can try over-the-counter remedies like pads to stop them rubbing, or take painkillers such as paracetamol or ibuprofen if they play up. Devices that fit into your shoe, called orthotics, or splints that you wear at night, can slow the progression of bunions.

If these don't help and the bunion is causing a painful and substantial deformity that’s seriously limiting your footwear, your GP will probably refer you to see a podiatrist -  medical professionals who specialise in feet. They can give further advice about non-invasive treatments and also refer you for an operation - either with a podiatric or orthopaedic (bone) surgeon - ultimately the only thing that can correct the gnarly blighters.

You can visit a podiatrist privately, which will cost anything from £140-£200. But Mike O’Neill, spokesperson for the Society of Podiatrists and Chiropodists, suggest always going via your GP, who will know the best qualified.

Such is the complexity of the bone structure of the foot, there are more than 130 different surgical procedures for bunions. One person’s op may be very different from another’s, so be wary of sounding out a friend about theirs.

The most simple procedure is reducing the bump, and while there will be a little pain and swelling afterwards and your mobility will be restricted, the recovery time is short (ie a few weeks), but it may not fix the underlying cause. More serious ops might involve lasers, robots, cutting bone in the foot and trying to reposition it, and/or inserting pins or wires. It can take months to recover fully and you might need a cast. Mike O’Neill recommends seeking an NHS consultant surgeon who specialises in bunion removal to ensure the best possible outcome.

The type of anaesthetic, local or general, will depend on the procedure, but most are day cases and the surgery will take from less than 30 minutes to a couple of hours. Waiting times vary but from your first outpatient appointment to the op would be a minimum of a few months. Private treatment (preferably by an NHS consultant surgeon) is likely to cost thousands of pounds.

A new less, invasive procedure called surgical correction of hallux valgus that makes a small incision in the bone  has recently been approved for use in the NHS but there is still no conclusive evidence on how effective it is and it is not widely available.

Is surgery for a bunion advisable?

According to the NHS, 85 per cent of operations are successful, but there’s no guarantee that the problem won’t recur, that the pain will go away, or that your movement won’t become limited. Ask yourself if the affront to your vanity and discomfort caused by your bunion is worth the post-op suffering, and if you can cope with the inevitable restriction on your movement that means no driving and time off work, even if only for a few weeks.

For further information, visit www.feetforlife.org

Hilly Janes

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