Ask the Doctor: How Can I Treat My Bunions Without Surgery?

Question: I have bunions and was wondering if there is anything I can do to help other than surgery. I know I’ll probably need it at some point, but with work, family, and other commitments, I can’t lie down for weeks anytime soon. do you have any advice

dr Grant replies: A bunion is a bony deformity of the joint at the base of the big toe that causes it to move toward the smaller toes. The degree of movement or angulation of the big toe helps determine the severity of the problem.

One of the most common signs of a bunion is inflammation, which typically causes pain, redness, and swelling over the medial (internal) bursa that protects what’s known as the first metatarsophalangeal (MTP) joint.

The exact reason why bunions form is poorly understood. It’s thought to be multifactorial – family history and tight or ill-fitting footwear are two major contributing factors. Foot anatomy, joint hyperflexibility, and foot biomechanics may also play a role. Interestingly, bunions are rarely seen in parts of the world where people go barefoot. Other contributing factors include an underlying diagnosis of rheumatoid arthritis, psoriatic arthritis, or gout.

Since not all bales become heavy, there may be a threshold up to which the forces causing the deformity can be counteracted. When forces greater than the threshold occur, the joint deforms. Such progression may occur rapidly, rather than steadily deteriorating over several years.

Sometimes people can identify a specific activity that causes pain in the first MTP joint. For example running. Have you picked up an exercise recently that might help? Runners can experience pain and swelling in this joint when they travel long distances or switch to a new brand or style of shoe.

In people over the age of 50 it is possible that early degenerative changes (osteoarthritis) could be a possible cause of the bone belly. Early OA changes can be seen on an MRI scan, and more established OA are noted on a foot X-ray.

A foot x-ray allows one to clearly see the structure of the foot, as well as the degree of movement and deformity caused by the bunion. All in all, the majority of people with a mild bunion and not severe symptoms do not warrant X-rays or other imaging tests.

There are many conservative options for treating bunions, although none have been shown to be statistically significantly effective in clinical trials.

These include wearing wide fitting footwear, putting orthotics in your shoes, wearing splints at night, wearing toe separators (soft wedges placed between the first and second toe) during the day, or undergoing manipulation – and stretching exercises under the guidance of a trained professional, with repetition of these exercises at home. Surgical correction is generally only considered for more advanced deformities and when there is severe pain or discomfort.

In your case, I think it’s a good idea to see a physical therapist to assess your foot anatomy, arch, biomechanics, and overall gait.

dr Jennifer Grant is a GP at Beacon HealthCheck Ask the Doctor: How Can I Treat My Bunions Without Surgery?

Fry Electronics Team

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