How to Address Bunions

April Leonard likes to blame her bunions on her husband. In 2017, she accompanied him to a podiatrist appointment for calluses—and went home scheduled for surgery to correct her misaligned toe bone.

In retrospect, it was a good thing. “He said, ‘I’d really like you to have this done now, because it won’t get better,’” recalls Leonard, 56, of that unexpected first conversation with the doctor. She had painful bunions on both feet and had started to have trouble handling daily chores on her farm in Missouri. Plus, she didn’t like how they looked. “When I went to the pool or the beach and would look at my feet, it was like, ugh,” she says. So in 2017, Leonard had a Lapiplasty bunion correction procedure done on her left foot; four years later, she had it on her right foot.

worldwide have bunions—and the deformity, which is particularly prevalent among older people, is more likely to affect women than men. But you wouldn’t know how common bunions are based on the level of discourse surrounding them; they’re not exactly considered dinner-party conversation. That should change, experts say. “It’s not talked about a lot…but it is an insecurity that patients have,” says Dr. Dana Brems, a podiatric foot and ankle surgery specialist in Los Angeles. “People say they feel uncomfortable wearing open-toed shoes or sandals because of the appearance of the bunion.” More discussion about bunions, including how they affect quality of life and what to do about them, could help alleviate that stigma, she adds.

A genetic predisposition

If you have a bunion, your first metatarsal bone—which is just behind the big toe—will gradually shift sideways toward the other foot. “It’s not sitting straight on the mid-foot bone. It’s being kind of lazy and leaning towards the side,” says Dr. Ebonie Vincent, a podiatrist in Irvine, Calif., and star of My Feet Are Killing Me on TLC. Visually, you’ll notice a bump at the base of your big toe—and probably feel pain there, especially while exercising or if you wear narrow shoes. You might notice swelling or redness around your big toe, develop corns or calluses, and find that you have limited toe movement.

Bunions are typically caused by a genetic predisposition, says Vincent, who sees them on patients at least a few times a day. Most people who have them report that their mom or grandmother or great-grandmother did, too. Some are progressive and become bigger—and more painful—over time, especially with intensive activity or as a result of shoving your feet into ill-fitting shoes. Not everyone who has them, however, will experience pain. “There are people who have lived and died with bunions very happily,” Vincent says. In those cases, they’re little more than a cosmetic nuisance. But for others, they can make life a lot more annoying.

Unpleasant complications

When new patients arrive in Dr. Geoffrey Phillips’ office, they’re often focused on how their foot looks—but the orthopedic surgeon at Northwell Health in Great Neck, N.Y., is more concerned with how it’s functioning. “We look at the profile, or as I like to say, the personality of the foot,” he says. “We like to make sure patients have happy feet: feet that function well and without associated pain.”

That includes figuring out if a bunion is leading to nefarious side effects. Once people have a symptomatic bunion, Phillips says, there’s a “fairly high frequency” of other problems involving the foot. Some patients, for example, will develop osteoarthritis over time as the result of an untreated bunion. Others might experience swollen nerves. Many have trouble with the adjacent toes and develop a hammertoe—in which the toe has an abnormal bend in the middle joint—or a crossover toe. “The second toe starts to cross over the first,” Phillips says. “You essentially have a crisscross, and you have the first deviating to the second, and the second deviating to the first.” When that happens, surgery is typically required for the toe to resume its normal position.

How to find relief

The main reason why people go to the doctor about their bunion is because they’re experiencing pain, Phillips says. Some can make lifestyle modifications that eliminate the need for surgery, especially if they start when their bunion is still in its early stages. Phillips’ first recommendation is to make footwear changes. “If they’re accustomed to wearing high heels, we try to change that reliance to more balanced shoewear,” he says. “That can include shoes with a wide toe box, so there’s less pressure on the foot.” It can also be helpful to seek out “rocker bottom shoes,” which have a curved sole that smoothes out the transition from heel-strike to landing on the front of the foot.

When you’re considering footwear, look for a comfortable pair with good cushioning that fits; you don’t want your feet to be wedged in or slipping around, Phillips says. If you need to wear leather or dress shoes, ask a cobbler to stretch them out: “They have machines that can stretch out the toe box so there’s greater space for the toes,” he says. Custom orthotics, which are inserts based on scans of your foot, can also be helpful.

People with bunions are often enticed by quick-fixes on the internet, like toe slings and bunion splints. Some buy toe spacers, which are placed between the toes to reduce pressure on the joint. “They’ll relieve pain while you’re wearing it,” Vincent says. “You’re not fixing anything. You’re putting your bones in more of an aligned position so they function better while you’re walking.” When you remove the toe spacer or take off the sling, your bunion will still be there—painful as ever.

Podiatrists don’t tend to operate on bunions just for cosmetic reasons, but bunion correction surgery is the go-to treatment for people who experience continuous pain and find it difficult to walk. There are various types of surgery, most of which involve cutting and repositioning the bone at the base of the big toe. Lapiplasty—the procedure Leonard had in Missouri—is a newer technique approved by the U.S. Food and Drug Administration in 2016. In addition to returning the bone to its normal alignment, the unstable joint in the foot is secured with titanium plates.

People can generally walk immediately after surgery, but they need to wear a special post-surgery shoe, like a boot, for at least a few weeks. “That’s just unavoidable—solid bone takes six to eight weeks to heal,” Brem says. “You’ll probably be back to full activity after around three months, running and jumping and that sort of thing.”

Five months after Leonard had her left bunion removed, she ran a 10K race. Within a year, she was running half marathons again. Now, she’s pain-free and happily wears running shoes, muck boots, and cowboy boots around the farm. “It’s been a really good thing—I wish I had done it earlier,” she says. “It’s not a debilitating surgery. I can see why people wait longer to do it, but six weeks [of recovery] is nothing compared to the rest of your life.”