Anthony L. Komaroff, M.D.
— DEAR DOCTOR K: I have a bunion on my left foot and it hurts! What can I do?
DEAR READER: With a bunion, your big toe turns inward, bending toward, or even under, the other toes. Since your feet probably are inside shoes and not easily visible, I'll try to explain what happens to your big toe by asking you to look at your hand. Look at your thumb. Feel the joint where the thumb starts sticking out from the hand. Unless you have arthritis, the bone in your hand and the first bone in your thumb are lined up pretty straight.
If your thumb developed a bunion, the bone in your hand would be pointing outward and the bones in the thumb would be pointing inward.
Bunions most often result from shoes that squeeze the toes into pointy or narrow toe boxes. This forces the toes to fold over one another to fit in. Over time, a bunion develops. At first, it's just a little ugly, and it can make it hard to get into shoes. It may not even hurt.
If and when it does begin to hurt, there are several things you can do to ease your discomfort. You can pad the bump with felt or moleskin. Or try a shoe stretcher to stretch the front of your shoe, relieving pressure on the bunion part of your foot. Shoe inserts called orthoses can redistribute your weight so the bunion doesn't constantly rub against your shoe. Foot doctors called podiatrists can fit you with these inserts.
For pain, try NSAID pain relievers such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Hot and cold compresses may also help.
If you continue to experience significant pain, you may need to consider surgery. Surgery will partially or completely restore your toe to its normal position. The specific procedure will depend on the severity of your condition.
During recovery from bunion surgery, you may have to wear a bandage and special shoe, or possibly a cast if your case is more severe. The special shoe or cast will protect your foot, allowing it to heal, while enabling you to walk on your heel. Sometimes you need to stop putting weight even on the heel of the foot that has had surgery, and use crutches or other devices. You will also have to stop driving for about six weeks.
After the special shoe or cast is removed, you need to do exercises to regain your strength and flexibility. It can take six months to recover fully.
We have more information on bunions in our Special Health Report, "Foot Care Basics." (Learn more about this report at AskDoctorK.com, or call 877-649-9457 toll-free to order it.)
In the future, wear shoes that provide sufficient room in the toe boxes. We're not talking tennis shoes -- there are plenty of attractive shoes that qualify. This can help to prevent future bunions from developing, or keep existing ones from getting worse.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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