There are many conditions in the foot in which non-surgical therapy can be highly effective in relieving. Therapies can include medication, injections, shoe modifications and inserts, physical therapy, and plain old ‘time to heal’. Unfortunately, there are limited options for those with painful bunions. Surgery is usually recommended for those who are experiencing significant bunion pain. Bunion surgery usually requires healing for six weeks in a walking boot or cast depending on the required procedure and surgeon preference. Due to this lengthy recovery time, it is not uncommon for many to delay having surgery. This can be in part due to a current responsibility to family or work in which they cannot devote the necessary recovery time, and in some cases there are those in which surgery is not advised due to health issues and an anticipation of serious anesthesia or post-operative complications. For those unable to have surgery to relieve the pain, there are some options available to lessen the pain and to restore some normal function to the foot. One simply does not have to ‘deal with it’ without a chance for some relief. It should be noted that none of these options fix the bunion. However, in some cases, non-surgical treatment can make the condition tolerable.
First of all, lets discuss what a bunion really is. Bunions are a complex foot deformity of both bone and the soft tissue that attaches to the bone at the big toe joint. Essentially, the bone at the big toe joint will stick out and become very prominent against one’s shoe. The big toe will gradually drift over to rest near the second toe. Popular opinion not withstanding, bunions are not caused by tight shoe use. One’s feet have not been ‘moldable’ since early childhood, and a tight shoe will not alter the position of one’s bones. However, a tight shoe can aggravate a bunion, and a previously non-painful bunion can suddenly become painful. Bunions are usually inherited from one’s parents or grandparents and have several underlying causes. The most common cause is flat feet. Over time, muscular changes needed to adapt to walking with flat feet will contract the great toe towards the second toe, and make prominent the 1st metatarsal head (bone) on the inside of the foot. This can create pain in the bunion when rubbed against tight shoes. Joint pain in the great toe can develop over time due to its abnormal position and eventually arthritis will develop. The great toe can also crowd into the lesser toes, causing an over or underlapping of the second toe. Other causes for bunions could include injury to the bone or big toe joint, or birth deformities which alter the position of the bone from the start of growth.
The first step for non-surgical relief is to simply obtain wider shoes. One has to swallow their fashion pride and buy a shoe that is actually as wide or ideally wider than the foot in order to reduce shoe rubbing on the bunion, which causes the majority of pain for most bunion sufferers. As the enlarged bump of the bunion crowds into the side of the shoe, it can become severely inflamed. By keeping the side of the shoe away from the bunion, one can reduce the inflammation and thus reduce the pain. A shoe must also be supportive to decrease abnormal stress to the big toe joint. This means no heeled shoes, no pointy dress shoes, and no hard leather shoes. Overall it also means buying a shoe in a store that carries several widths of a shoe in each size, not just a convenient department or discount store with a limited selection. Simply buying the next size shoe up can cause problems as the foot will slip in the longer shoe, even if the width is greater in the bigger shoe. This slippage can cause problems all on its own. The selection of proper shoes alone reduces a good deal of bunion pain.
Another technique can include padding over the bunion bump. Many companies make ‘bunion shield’ padding that fits over the toe and includes a soft pad that covers the bump. The primary material is usually a stretchy elastic, and the padding is usually a gel or foam. This kind of device can help in some cases, although this author’s typical professional experience has been that the padding simply makes the shoes tighter. It is also inconvenient to continue to apply the padding daily.
Since most of the pain associated with a bunion is due to inflammation of the tissues surrounding the big toe joint, your foot doctor can prescribe anti-inflammatory medications or inject cortisone-like steroid compounds into/near the joint to relieve some of the inflammation. For some, this step can provide some level of temporary relief, although injections may wear off and medications will need to be continued daily. Medications can have side effects, and not everyone can take them. Those with stomach ulcers or kidney disease should not take anti-inflammatory medication, although there are exceptions. Injections of steroid compounds are generally safe, but since the great toe joint is variable in it’s deformity, the effectiveness of an injection depends solely on the severity of the bunion and the aggravation of the surrounding tissues.
A final non-surgical treatment to help reduce bunion pain comes in the form of addressing the underlying cause of the bunion in the first place. This cause is due to faulty foot structure that leads to instability of the joint. Usually due to flat or flattening feet as discussed above, this process worsens the bunion to a miniscule degree with every step. By forcing the foot to function in a normal position, an orthotic (prescription shoe insert) can help reduce the worsening of the bunion by controlling the position of the foot. This may also provide some pain relief as the foot becomes more stable. Store-bought inserts will not provide the same level of stability, and are usually ineffective for bunion pain. They do not control the foot structure specifically enough to change the subtle mechanics affecting the big toe joint, and simply serve to improve arch comfort.
If those of you reading this are part of the many people delaying their bunion surgery due to other issues at home or work, remember that you DO have treatment options for relief. Your bunion will not be cured, but you may be comfortable enough to keep active until you are able to have surgery performed.
Author Resource:-
Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website at www.inpodiatrygroup.com
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