BUNIONS are bumps or lumps that develop on the inside of the foot at the base of the big toe. They occur when the big toe moves out of its normal alignment, a condition known as Hallux valgus.
The fluid-filled tissue bag that lies over the big toe’s main joint becomes inflamed, causing a swelling. Eventually the toe twists out of alignment with its corresponding metatarsal (foot bone), which starts to grow extra bone to bridge the gap. The big toe can move so much that the inside edge touches the ground and the outside turns upwards.
At first, a bunion might be only a cosmetic worry, but if left untreated it can deteriorate and become extremely painful. In advanced cases patients lose mobility in the toes, and adopt an unnatural compensatory gait that can lead to arthritis.
Bunions can be caused by flat feet or low arches, which can cause the foot to bend out of its normal shape, but shoes are more likely to be responsible. For this reason the condition is much more common in women than men.
To prevent bunions, wear shoes with wide insteps, broad toes, soft leather and a half-inch of space at the front. Sandals are especially good. Avoid footwear that is short, tight, pointed or has heels higher than 5.5cm (2¼in). If a bunion develops, reduce the swelling by taking anti-inflammatories such as ibuprofen or by using ice-packs. Bunion pads can also help to reduce pressure.
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Once a bunion has reached an advanced stage, though, a “bunionectomy” might be needed. A surgeon chisels off the bony protuberance at the end of the metatarsal and repairs the ligaments and tendons. Pins, screws, plates or wires might be used to stabilise the new toe position.
Patients often have to use crutches or a wheelchair for several weeks after the operation, and recovery can be long and painful.
JEREMY HAZLEHURST