Dr Daniel Wu - Taking Steps to Ease Bunion Pain

Of all foot ailments, the bunion is probably the best known and most troublesome.

It affects predominantly women with more than 90 per cent of cases occurring on the feet of females.

Although high heeled and pointy-toed shoes have been commonly blamed for bunions (hallux valgus), heredity and female hormones are actually much more important factors.

Studies in the past have found strong correlation between the adoption of ordinary Western shoes and significantly increased incidences of bunion deformity in previously barefoot societies.

In 2008, a survey of 1,000 Hong Kong Chinese women conducted by Hong Kong Baptist University found 83 per cent of bunion sufferers in Hong Kong had rarely worn high heels in the past, but 88 per cent had family history of bunions.

Although bunion deformity initially may seem to be a cosmetic problem, it is a progressive condition which can result in pain and deteriorating function of the big toe. As the big toe is the most important part of the forefoot used in pushing the body forward in walking, severe bunion deformity can make simple daily activities a chore.

A bunion is also the underlying cause of many secondary problems, such as painful calluses, clawing of the lesser toes, bunionettes and the collapse of both arches in the foot.

Bunion deformity has also been wrongly labelled a condition of deformed bones which has led sufferers to endure bone-breaking surgeries as a solution. On the contrary, it is mostly a soft tissue problem involving weak ligaments.

Basically, a bunion is formed by bones shifting out of their normal positions due to the failure of supporting ligaments. These displaced bones are responsible for most of the function of the forefoot and their displacement undermines the very basic walking function of foot.

Unfortunately, treatment is somewhat limited. There is no known non-surgical method to reverse the deformity. Nor is there an effective intervention to prevent formation or worsening of the deformity.

There are only unproven devices which attempt to slow down the progression of the deformity and reduce some discomfort.

Anti-inflammatory medications and physiotherapy can help reduce pain temporarily but roomier, softer upper and thicker soled shoes with specific shoe inserts are more effective in limiting bunion pain. Avoiding high heels and choosing only comfort shoes may not alter this ailment’s natural course of progression, but it can help delay the need for surgery.

If pain becomes unmanageable and begins to interfere with a person’s lifestyle, then surgery may be considered. In the past, surgeons and patients were faced with the daunting task of choosing from a record-breaking 130 procedures for bunions. Fortunately, the choice has become easier with the advent of the computerized function scanner. These scanners not only help identify the types of surgery which can consistently restore normal foot function, but are also able to verify the success of each surgical case in terms of function improvement.

The function test is now an integral part of bunion surgery and not only demonstrates whether a foot is able to function again correctly but also the reason behind any possible residual pain and calluses.

This is important if bunion surgery is to be rightly seen as an important step in addressing a function problem of the foot and not simply a cosmetic procedure.

In conclusion, the causes and problems of bunion deformity are often trivialized and underestimated. The most practical way to manage bunion pain is to wear comfortable shoes. However, if necessary, surgery can be performed to help restore normal function and allow an active and healthy life.

Source: Dr Daniel Wu, Yiang, Specialist in Orthopaedics & Traumatology at Hong Kong Adventist Hospital