Better Bunions

Following my recent article on foot ailments, readers wrote in asking for more information about bunions -- those painful, swollen bumps on the outside base of the big toe or pinky toe-- and what they could do to ease their pain without surgery. To get the lowdown, I spoke with Carolyn Fuller, ND, a naturopathic physician at the Bastyr Center for Natural Health in Seattle, Washington. She told me that bunions can have a far greater impact than just discomfort, posing structural challenges not only for the foot, but for the entire body.

Everything's connected, explains Dr. Fuller. If you change the way you stand and walk (in medical parlance, that's your stance and gait) in order to compensate for a painful bunion, you can cause poor alignment in the rest of your body, which in turn creates pain in the foot itself as well as upward into the hips, back and even neck. So don't take a grin-and-bear-it attitude towards bunions... take action. Otherwise, these bony overgrowths may wreak more havoc on your body than you realize.

A STRUCTURAL PROBLEM

Bunions are essentially a structural problem. Normally, the big toe is straight -- but when you have a bunion, instead it leans into the second toe, causing the big toe's first joint to protrude. Another and less common type of bunion, known as Tailor's bunion, occurs at the base of the pinky toe. Bunions are caused by misalignment of the toe joint. Flat feet and accompanying pronation (a tendency to walk with an inward rolling of the foot) predispose people toward developing them. As with most foot ailments, however, Dr. Fuller observes that a major part of the problem is usually poor-fitting footwear, which aggravates and perpetuates bunions, making women particularly vulnerable.

EARLY ATTENTION IS A MUST

Bunions only get worse over time, so early attention is a must. Over time, as the big toe angles in farther and farther toward the other toes, the base of the toe grows increasingly prominent, painful and swollen. As the inflammation worsens, so does pain with wearing shoes and walking. The big toe may come to overlap with the second toe, either under or over it, leading to even more inflammation and pain. Left unattended, a bunion will eventually change the shape of your foot.

HOW TO COPE WITH BUNIONS

Fortunately, there are a variety of helpful ways to cope with swollen and tender bunions. Although you can try some of these on your own, Dr. Fuller generally recommends seeing a health-care professional to make sure you're on the right track.

What you can do...

• Wear comfortable, well-fitting shoes. This is a must with any foot ailment. When it comes to bunions, choose shoes with wide widths and large toe-box areas, and shop for them in the late afternoon since feet swell as the day wears on. Do not wear high heels, or for that matter any shoes that are too tight and squeeze the toes together. If you have a pair of shoes that you like but suspect are irritating the bunion, take them into a shoe store or shoe repair shop. There are devices that can stretch the leather to accommodate bunions.

• Wear over-the-counter (OTC) padding. Padding such as moleskin, felt or foam can offset some of the painful pressure on a protruding bunion.

• Use orthotic devices. These are special inserts you put in shoes to control the biomechanics of the foot. They cannot cure bunions, but orthotics can help correct the structural abnormalities -- flat feet and rolling your feet inward when you walk -- that contribute to them. Dr. Fuller recommends getting fitted by a podiatrist. If you pick out an OTC shoe insert at the local drugstore, you may choose one that is too thick or too thin or wrongly position it. The wrong insert can make matters worse. So invest the time and money in proper inserts.

• Consider spacers. These are devices you place between the toes to prevent toe overlap. As with orthotic devices, Dr. Fuller advises that you consult a health-care professional rather than buying spacers over the counter.

• Treat sore feet to a hot soak. While this will do nothing to alter the underlying structural problem, it will reduce inflammation and ease discomfort, says Dr. Fuller. A good revitalizing footbath consists of three to five drops of an essential oil (such as peppermint, lavender, rosemary, cypress or tea tree) and one tablespoon of Epsom salts in a bowl of hot water. Soak feet for five to 15 minutes.

• Massage away pain. Like soaking your feet, this won't make a bunion go away, but it can relieve some of the associated soreness and discomfort. To make your own massage oil, combine several drops of your favorite essential oil with a tablespoon of arnica oil, which is particularly soothing for aches and pains. (Caution: Do not use arnica on broken skin.) If you don't have arnica oil, you can use hypericum (St. John's wort) oil instead.

• See a physical therapist. Physical therapy can help you retain or even improve flexibility and range of motion, which is otherwise likely to decline with bunions as time goes on. A physical therapist can also teach you stretching exercises you can practice on your own to keep the joint mobile.

When all else fails, surgery may be necessary. Unfortunately, this is the only real cure for bunions. But chances are it won't come to this if you act early, choose several of the more conservative measures recommended above and faithfully adhere to them. In particular, there's no substitute for shoes that fit correctly.

Be well,    Carole Jackson, Bottom Line's Daily Health News

Sources:  Better Bunions, Carolyn Fuller, ND, Bastyr Center for Natural Health, Seattle, Washington.