Dr. Miguel Cunha answers the most asked questions about bunions.
Q. What are bunions and what typically causes them?
A Bunion is a structural deformity involving the first metatarsal, causing a painful bump on the side of the forefoot near the great toe. Bunions form when the big toe rotates sideways towards the second toe. The first metatarsal shifts in the opposite direction, gradually changing the angle of the bones that make up the great toe joint. This produces the characteristic bump, which increases prominently over the years.
Bunions are caused by nature, as they are genetically inherited and can progress more rapidly over time because of nurture, such as the use of improper shoe gear. Women are 10 times more likely than men to develop bunions because women are more likely to wear narrow, tight, and pointed-toe shoes that force the big toe inward, and place increased pressure on the first metatarsal.
Q. What can be done to treat a bunion? At what point is bunion surgery necessary?
Surgery is the only way to correct a bunion, however not all bunions require surgery. The best treatment for bunions depends on the severity of pain, medical history, how rapidly the bunion has progressed, and if pain relief can be achieved with conservative non-surgical treatment. Mild symptoms can be addressed conservatively by wearing more comfortable shoes and using custom orthotics, padding and/or splints to support your toe in a more normal position. Topical medications, icing, and stretching exercises can also help alleviate symptoms of pain and suffering. When conservative treatment fails, surgery is recommended to help correct the misalignment of the great toe joint.
Q. What could happen if you do not treat your bunion?
Overtime, bunions can worsen in appearance and symptoms. Poorly fitting shoes such as heels or shoes that lack proper arch support, can cause bunions to become more prominent in severity and to progress more rapidly over time. If left untreated a bunion can further cause athritis and/or the cartilage in the joint to deteriorate. A progressive bunion will require a bigger surgery. Also, keep in mind that a bunion can be corrected with surgery, but athritis and the possibility of chronic pain are not curable. Therefore, it's my recommendation that a bunion is corrected earlier than later.
Q. What type of job or activities is most bothersome to someone with a bunion?
Bunions are especially bothersome to people whose jobs involve a lot of standing and walking such as nursing, teaching, and serving in restaurants. Exercising, and especially running and dancing, with bunions can be a painful experience.
Q. Can running make a bunion worse or lead to more discomfort?
Bunions occur because of a biomechanical imbalance involving the first metatarsal and can progress more rapidly in feet that are flat and overpronate. Walking or running in shoes that lack proper arch support can lead to overpronation, which can in turn contribute to an increased imbalance and structural deformity of the great toe joint.
Q. Which sneakers do you recommend for someone with a bunion?
For those suffering from bunions, I recommend the following shoes:
New Balance Fresh Foam 860v11
ASICS Gel Kayano 27
Saucony Echelon 8
Brooks Beast 20
Mizuno Wave Inspire 16
Hoka Arahi 4
These all offer the following desirable features:
The companies of shoes noted above stand above the rest because they invest more of their time and money into the medical research of human gait and biomechanics and shoe design to develop a more well engineered shoe, particularly in people who suffer from bunions.
Each of these shoes have Flexible Toe Boxes, firm midsoles, and rigid heel counters to provide flexibility in the forefoot where our great toe naturally bends while maintaining rock solid rigidity in the heel of the shoe to protect bunions with each step we take.
These shoes are specifically engineered with foot beds and molded EVA midsoles to help mitigate foot, heel, and arch support for superior comfort and support of the arch in people with bunions.
Spacious toe box that allows your toes to move freely with no restrictions therefore minimizing discomfort placed on a bunion deformity.
Well-cushioned footbed and anatomical arch support to hold the plantar fascia and prevent it from collapsing to minimize fatigue and pain that can aggravate bunion deformities.
Deep heel cup to maintain proper foot realignment and maintain pressure relief of bunions with heel strike. This will help maintain proper sagittal motion and minimize frontal plane motion which can lead to excessive pronation, collapse of the arch, and ultimately the progression of bunion deformities.
Biomechanically engineered shoe with a structured saddle, synthetic upper, cushioned collar and highly flexible and durable rubber sole with maximum shock absorbing properties and cushioning to maximize motion control, minimize arch fatigue, and ultimately allow for a smoother and more natural motion when walking.
Ultra-lightweight sole with a mid-foot support bridge. Some running sneakers will have gel padded heel-seat that is designed to contour to the shape of your feet or a polyurethane loaded foot bed and with memory foam to comfortably cradle your arches enhancing comfort and alleviating pain associated with bunion deformities.
Q. Can you evaluate a bunion through a virtual appointment?
During the pandemic I had many online appointments to initially discuss the possibility of a bunion surgery. A bunion is a visible condition however after discussing the condition and the spectrum of options ranging from conservative care to surgery, I always recommend that my patients come in to take some x-rays. X-rays are done on-site. This way I can better evaluate the severity of the bunion, the proper care as well as the right bunion technique if that is the desired path. A bunion surgery will significantly reduce or eliminate pain altogether as well as provide a more aesthetically pleasing foot appearance. Keep in mind, that there are many types of bunion surgery techniques. Your surgeon will go through each one that range from minimally invasive, to gold standard methods that will prevent the bunion from returning.
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