Even Celebrities Get Them - What Can Be Done About Ugly Bunions?

Even the otherwise flawless Victoria Beckham has been troubled by bunions which make ugly bulges in her expensive high-fashion shoes.

What exactly are bunions?

The term refers to a bony deformity of the big toe joint, known medically as hallux valgus.  (Hallux is the medical term for the big toe, and valgus means away from the midline of the foot). To understand exactly what this is you need to know the anatomy of this area. 

The base of each toe is joined to a metatarsal bone (the equivalent of the long bones in the back of the hands called metacarpals).  The metatarsals fan out from their base near the ankle, with the distance between them increasing as they approach the toes.  But in the case of bunions, the distance and angle at the base, between the first and second metatarsals, increases with time.  

Effect of shoes

The foot is now wider and shoes start to press painfullyon that deformed big toe joint. 

As the condition progresses the second toe my lie over the top or ‘over-ride’ the big toe. This will lead to further pressure from, and distortion of, footwear.  Hard skin and corns may develop on top of the second toe, where it is rubbed by shoes. Walking will be difficult too, as the deformed foot cannot function as nature intended.

Rubbing of the enlarged big toe joint by shoes will cause pain, hard skin and corns, and the area may become inflamed – red, hot, painful and swollen – due to the friction and pressure from shoes.  A fluid-filled sac called a bursa sometimes develops over the joint to try to protect it from damage. As the bursa increases in size it will also be painfully rubbed by footwear and may even burst from all the friction.

The joint itself may also become damaged by the distortion of the foot, leading to degenerative changes i.e. arthritis to develop.  

So do shoes cause bunions?

No they don’t.  

  Also, although not as commonly as women, men - who generally don’t wear the type of shoes associated with bunions (high-heeled and narrow-toed ) - also develop bunions. And not all habitual wearers of such footwear develop bunions, so there are clearly other factors at work.

What we do know though, is that those types of footwear can make bunions worse and probably accelerate their development.  So there is still every reason to restrict wearing of high heels and ‘winkle-pickers’ to just those special occasions i.e. not wearing them daily.

If shoes aren’t the cause of bunions, what is?

It basically comes down to genes, the way you walk and possibly your sex.  If there is a history of bunions in your family, you have a greater chance of developing them. 

You might not realise it but walking is a very complex process involving muscles in your calf and a total of 26 joints in your feet!  It’s not surprising that there is considerable variation in the way each of us walks and sometimes this is less than optimal – leading to problems like bunions.  Women possibly have a greater risk, due to looser joints.

Is there any treatment for bunions?

As mentioned, although not the cause of bunions, footwear does play a part. So as prevention is always better than cure, avoid regularly wearing high heels (which tip all your weight down onto the ball of your feet) and narrow-toe shoes which push the toes together.

They will be able to analyze your gait (walking pattern) and spot variations likely to cause a problem. 

They can then advise on footwear and exercises if appropriate.  They may also give you special insoles (‘orthoses’)to wear in your shoes, which can correct your gait. These can sometimes be bought ‘off-the-shelf’, or you may need semi-customized or fully-customized insoles.  These will need to be worn in your shoes for the majority of the day. 

You are likely to need them for the rest of your life too – as they do not cure bunions – they can only slow bunion development by correcting faulty biomechanics.  And like spectacles, they only work when worn.

Can anything cure bunions?

To remove bunions the only option is surgery.  There are different types of procedureand a surgeon – either orthopaedic or podiatric (foot specialist) will advise on the best one for you. This will be influenced by your age, bone quality, level of activity and severity of the bunion.

What’s surgery like?

It is often done under local, rather than general anesthetic, meaning they do not put you to sleep but give you injections of local anesthetic in the foot and ankle. You may also be given sedation, so that you are conscious, but not aware of what is going on, and will have no memory of it afterwards. You may have to stay in hospital for a night or two.

How long does it take to recover?

You will not be able to bear weight on the foot at all for the first few days, then weight-bearing will gradually be re-introduced.  You will need to wear a surgical shoe for three to six weeks until the swelling goes down.

Driving sooner than advised by your surgeon may invalidate your car insurance.