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DEAR MAYO CLINIC: Is it best to have bunions surgically treated before they begin hurting, or do some never cause pain? In the past few months, I've noticed throbbing from the bunion on my left foot, and I’m considering surgery. I have one on my right foot, too, but it doesn’t hurt. Will I eventually need the procedure done to both sides?
ANSWER: Not all bunions require surgery, and more conservative means of treatment typically are recommended first, before any surgical intervention is used.
A bunion is a bony bump that forms on the joint at the base of your big toe. It develops due to a shifting or repositioning of some of the bones in the front part of the foot (forefoot). When this happens, the big toe gets pulled toward the smaller toes and the forefoot widens. That’s when you start to notice the bump.
Some bunions don’t cause any symptoms other than a bulging bump, while others trigger swelling, redness and soreness around the joint. Persistent or intermittent pain may accompany a bunion, and the skin over a bunion may become red and sore.
When a bunion doesn’t cause pain or other symptoms, it may not require treatment. If, as in your case, a bunion does become painful — or if it causes other bothersome symptoms — that’s the time to make an appointment to have it evaluated. Doctors who specialize in foot and ankle surgery typically are the health care providers best suited to assess a bunion and help you decide on the appropriate treatment.
One of the first steps your doctor may take is to determine the underlying cause of the pain associated with your bunion. In some cases, it may be an internal problem, such as degenerative or inflammatory arthritis. In others, the pain could be from an external source, such as pressure from tight or ill-fitting shoes. Treatment recommendations may be based in part on what’s causing the pain.
Nonsurgical treatment options, which usually are the first line of treatment for bunions, often include changing the type of shoes you wear. Roomy, comfortable shoes with plenty of space for your toes will take pressure off a bunion and may help ease pain. Adding padded inserts to your shoes distributes pressure more evenly when you move your foot, and that can help reduce pain, too.
You also can try bunion pads to take pressure off the bunion. They are available without a prescription at most pharmacies and drug stores. Nonprescription pain relievers such as acetaminophen, ibuprofen or naproxen sodium may be useful, as well. In some cases, your doctor might recommend a cortisone shot to help reduce inflammation in the joint that could be triggering bunion pain.
If pain or inability to do your usual activities continues despite these more conservative measures, surgery may be necessary. The purpose of bunion surgery is to correct the foot deformity, increase function and reduce pain. The specific procedure used will depend on your situation.
You should have a discussion with a foot and ankle surgeon to talk about surgery options. He or she can outline the planned procedure and review the expected outcome and healing timeline, along with the potential benefits, risks and complications of the surgery.
A bunion may occur just on one foot or on both feet, and the severity, symptoms and progression can vary greatly from one foot to the other. Therefore, let your symptoms, as well as a discussion with your doctor, guide you when considering bunion surgery. — Dr. Martin Ellman, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota