DEAR MAYO CLINIC: I developed bunions in my teens and they have grown over the years. Now I cannot wear shoes without some discomfort. Over the past few months, I've noticed throbbing from the bunion on my left foot, although the one on my right foot is fine. My friend who had a bunion surgery said the surgery is invasive, and I'm concerned since I am an active person. Is surgery the only treatment option?

ANSWER: 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, or the 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.

It is estimated that up to 30% of the population will develop bunions. But not all bunions affect walking or ever require treatment. Some bunions do not cause any problems, while others trigger swelling, redness and soreness around the joint.

When a bunion becomes painful, or if it causes other bothersome symptoms, you should make an appointment to evaluate it. Typically, foot and ankle surgeons are best suited to assess a bunion and help you decide on the appropriate treatment. Depending on your situation, more conservative treatment ― or no treatment ― may be recommended before any surgical intervention.

During your visit, the provider should determine if the underlying cause of your foot pain is associated with your bunion. In some cases, it may be an internal problem, such as degenerative or inflammatory arthritis. In other cases, 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 ease pain. Adding padded inserts to your shoes distributes pressure more evenly when you move your foot, and that can reduce pain, too.

You also can try bunion pads or braces to take pressure off the bunion. These pads are available without a prescription at most pharmacies and drug stores. However, the pain and deformity cannot be corrected permanently with pads or braces. Nonprescription pain relievers such as acetaminophen, ibuprofen or naproxen sodium may be useful, as well. In some cases, your surgeon might recommend a cortisone shot to reduce inflammation in the joint that could be triggering bunion pain.

If pain or inability to perform your usual activities continues despite these more conservative measures, surgery may be necessary. This surgery seeks to correct the foot deformity, increase function and hopefully reduce pain. The specific procedure used will depend on your situation.

You should see a foot and ankle surgeon to discuss surgical options. Previously, bunion surgery meant a large incision and a long recovery, including the potential to be in a cast for up to six weeks. Over the past few years, innovations in surgical technique, equipment, technology and philosophy have made a less invasive procedure possible, with possibly faster recovery. Today, many surgeries require an incision of less than one-half inch, and patients can put at least some weight on the foot and walk within a few days.

It is important to speak to your surgeon about 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 on just 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, and a discussion with your health care provider, guide you as to the best treatment. — Dr. Glenn Shi, Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida

The post Mayo Clinic Q and A: Bunion treatment and surgery appeared first on Mayo Clinic News Network.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:59) is in the downloads. Read the script.

Poorly fitting footwear can cause foot pain, injuries and even deformities.

“Oftentimes, people wear shoes that are not fitted for them.”

Dr. Shi says opting for style over a good fit can really cause problems. For example, some flip-flops don’t give the sole of your feet enough support, prompting aching arches. And high heels, especially those that are too narrow, put pressure on the small bones in your toes, possibly resulting in bunions, hammertoes or neuromas. Neuromas are painful thickening of tissues around nerves, often occurring between the third and fourth toes. The good news is proper-fitting footwear helps. Dr. Shi has three tips to healthy feet.

“The best three ways to find good footwear is to, one, look at the sole.”

You want support with flexibility.

“The second thing you should really look for is consider finding a shoe that has a large toe box.”

The toe box should be large enough to hold your foot comfortably when standing.

“And, finally, find something that gives you a reasonable cushion.”

Comfortable padding between your foot and the floor.

The post Mayo Clinic Minute: Best shoes for healthy feet appeared first on Mayo Clinic News Network.

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

The post Mayo Clinic Q and A: Treating bunions appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, orthopedic surgeon Dr. Norman Turner III will discuss treatment for common foot problems and ways to prevent them. Also on the program, parasitologist Dr. Bobbi Pritt will have an update on the Lyme disease predictions for 2017. And critical care physician and sleep medicine expert Dr. Timothy Morgenthaler will try to help answer this common question: Why can't I sleep?

Here's your Mayo Clinic Radio podcast.

The post Common foot problems / Lyme disease update / sleep issues: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC:

ANSWER: In a situation like yours, surgery could be considered. But surgery is not the only treatment for bunions. More conservative measures may help decrease your symptoms and relieve pain. If you try them and they don’t work, though, then it would be a good idea to talk with a foot surgeon about surgical options.

The structure of your feet changes over time. Sometimes these are subtle changes that you do not notice. But in other instances, the changes are more substantial. Bunions happen due to changes that force the bones of your feet out of alignment and increase the width of your foot.

When a bunion develops, your big toe actually tilts or drifts away from the midline of your body, eventually crowding the second toe. The bone that is just behind the big toe, called the first metatarsal, drifts or tilts in toward the midline of your body. As the first metatarsal tilts in, it becomes more prominent. That is the bony bump referred to as a bunion.

Bunions are not always painful. As you describe, some people have them for a long time without any bothersome symptoms. But bunions may become painful for a variety of reasons. Shoes that are too narrow or too tight can make bunions worse. Skin irritation may develop on your feet due to the crowding of your toes. Over time, arthritis can develop in the big toe joint, as well. That may lead to pain and limit the range of motion at the joint.

When bunions become painful, there are several alternatives you can try before turning to surgery. First, if you have not already done so, make some changes to your footwear. To relieve pressure on bunions, try shoes with a wide toe box and soft leather uppers. If your shoes still bother you, you can have them stretched in the areas that cause irritation to make them more comfortable. Do not wear shoes with high heels or shoes that have seams in the toe box. Both can irritate bunions and make symptoms worse.

Pain-relieving medications such as acetaminophen, ibuprofen or naproxen may help control the pain of a bunion. Cortisone injections can be helpful in some cases, too. Talk to your doctor about whether they are right for you.

If these therapies do not give you enough relief, consider talking with a surgical foot specialist.  The goal of bunion surgery is to reduce the foot deformity, decrease pain and increase function.

Several surgical procedures can be used to treat bunions. No one technique is best for every problem. The type of procedure that would be considered is based on the severity of your bunions. In most surgical procedures for bunions, the bones are surgically repositioned for better alignment.

Bunions on both feet can be surgically corrected at the same time or at separate times. It is up to you and your surgeon to decide which approach is best for you. — Martin Ellman, D.P.M., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

The post Tuesday Q and A: With painful bunions, try other measures before turning to surgery appeared first on Mayo Clinic News Network.

October 15, 2010

Dear Mayo Clinic:

How bad do bunions have to get before surgery is required?

Answer:

Consider surgery when a bunion is painful every day, and you can no longer find comfortable shoes. But before surgery, exhaust all conservative approaches. Surgery to remove a bunion can be complicated and is not a quick fix. Recovery can take a few months.

A bunion is an abnormal bony prominence that develops on the base of the toe joint. Bunions usually occur on the big toes but the little toes can also be affected. The little toe version is called a bunionette. Not all bunions cause problems, but some are painful enough to interfere with day-to-day activities.

Bunions develop over time due to abnormal motion and pressure on the toe joint. Pain may occur over the bony prominence, which can vary in size. The joint at the base of the toe may be swollen, and the surrounding tissue may thicken. Bunions often occur in tandem with hallux valgus, a condition where the big toe is bent toward the second toe, pushing the bunion out past the normal profile of the foot. The resulting bulge on the side of the foot near the toe joint can be associated with intermittent or persistent pain.

Bunions usually are irritated by ill-fitting shoes. The worst offenders are high-heeled dress shoes with narrow pointed toes. Even when this type of shoe fits correctly and is not too tight, the design forces the shoe to bend the toes inward, causing friction and abnormal movement of the toe joints.

Not all bunions are related to shoe use. A hereditary structural defect in the foot can cause bunions. Arthritis can also contribute to bunions.

Most people can manage bunions successfully with conservative approaches including the following:

Shoes: The first stop is the shoe store. Shoes should have a wide, deep area for toes to avoid rubbing and putting pressure on the bunion. A shoe repair shop may be able to spot-stretch a shoe to reduce pressure in the area of a bunion.

Padding: Applying pads or cushioning around the bunion may help. Avoid over-padding, which might increase pressure.

Shoe inserts: They can help avoid abnormal foot motion. Options include over-the-counter arch supports or orthotics prescribed by a physician.

Medications: Over-the-counter pain relievers (acetaminophen or nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen) can help with pain.

When these approaches don't stop the pain, it's time to talk to a surgeon. Many different operations can help with bunions and related foot deformities. For example, the "bump" or damaged joint may be removed; the toe bones may be realigned or permanently joined (fused); or a portion of the bone may be removed. With so many options, it's important to work with an experienced orthopedic surgeon or podiatrist who has special training in foot surgery. And, it may be wise to seek a second opinion before making a final decision.

After surgery, patients may temporarily wear a surgical shoe or a cast. Some patients need to keep all weight off the foot for a time and use crutches or a knee caddy.

The goal of surgery is to relieve pain and improve function. Surgery should not be done for cosmetic reasons or to get patients back in high-heeled shoes. Done correctly, surgery can result in significant pain relief for most patients, although patients may not be totally pain free. And surgery may not help everyone. I encourage people to work closely with a specialist to determine the best medical and surgical treatment options for them.

— Gordon Weller, D.P.M., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

The post Surgery to Remove a Bunion Not a Quick Fix appeared first on Mayo Clinic News Network.