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Foot pain can affect everything you do

At first, Brenda Bumbrey just ignored the pain and swelling in the joints of her big toes. It was easy to attribute it to long hours on her feet and wearing uncomfortable shoes. But before long, she knew she needed to see a doctor.

"When your feet are in pain, your whole body is in pain," laughs Bumbrey, now recovered from surgeries to correct severe bunions in both feet. A young woman like Bumbrey isn't who comes to mind when people think of foot disorders like bunions. But that's a mistake.

So, what is a bunion?
"Bunions are progressive deformities that have an arthritic component as people age," says Virtua podiatrist Christopher LaRosa, DPM. "But I also see painful bunions in younger patients, especially women. This is caused by high-heeled shoes with narrow toe boxes that create excessive pressure on the toes." There is also a hereditary component to bunions: People with flat feet or low arches - traits that run in families - tend to develop bunions. So people who've heard about bunion pain in older relatives should be on the lookout for similar problems.

But what exactly does a bunion look like? A bunion is an enlargement of the bone and tissue at the base of the big toe. Bunions develop when the big toe starts moving toward the smaller toes because of abnormal pressure. This pressure crowds the toes together, eventually causing the big toe joint to push outward, creating a painful, visible deformity. Left untreated, bunions become larger and more painful, eventually making it difficult to walk or to even stand for a long period of time.

Treating bunions
Removing a bunion, a procedure called a bunionectomy, is considered a last resort in treating the painful condition. Dr. LaRosa explains: "Before recommending surgery, I want to exhaust every non-invasive option." This includes changing footwear and padding to relieve pressure on the joint, using shoe inserts to control movement that aggravates the condition, taking anti-inflammatory medications to ease pain and swelling, and receiving physical therapy for temporary relief.

"The final decision to have surgery depends on whether the patient's pain is unmanageable with conservative measures," says Dr. LaRosa. "If the pain is interfering with daily activities, than it's time for surgical correction; that decision is made cooperatively between patient and doctor."

The choice seemed obvious to Bumbrey. "I'm pretty active, and it just got more and more irritating," she says. "It got so bad I couldn't even get dressed without worrying about what I would wear on my feet."

Dr. LaRosa says: "The type of surgery depends on the severity of the condition. It also depends on the general health and activity level of the patient." While a mild bunion might only require the removal of the enlarged portion of the bone and realignment of the tendons, a more severe bunion might require a complete repositioning of the bone along with realignment of the tendons, ligaments and stabilizing structures. And if the joint is beyond repair, which is often the case with arthritis, joint replacement or fusion may be necessary.

An ounce of prevention
It's sometimes said that prevention is the best medicine; that's especially true of bunions. "I can't emphasize enough that people should wear comfortable, properly fitting shoes," says Dr. LaRosa. "Shoes with a narrow, pointed toe box can create problems and can exacerbate existing conditions; and when it comes to heels, the lower the better."

While surgery can correct bunions and alleviate pain, it's best to avoid developing bunions in the first place. And even after surgery, bunions can return if people continue to wear the wrong shoes.