Bunion Treatment

Most bunions^[22] can be treated without requiring surgery. While nonsurgical treatments don’t help improve the bunion itself, they can help alleviate pain and prevent the bunion from getting worse. Common nonsurgical approaches to treating bunions and their symptoms include:

• Wearing proper footwear: The majority of bunion pain can be managed by avoiding restrictive shoes and opting instead for those that fit correctly and accommodate the toes without crowding.
• Padding/cushioning: Adding over-the-counter, non-medicated bunion shields to your shoes can help cushion a bunion and prevent friction from worsening your pain.
• Orthotics and other devices: Both over-the-counter and custom-made shoe inserts called orthotics can help alleviate pressure and discomfort. Toe spacers can also help prevent the crooked big toe from rubbing against the second toe and creating a blister.
• Icing: Icing a bunion several times a day, especially after being on your feet for long periods of time, can help reduce inflammation and swelling.
• Medication: Over-the-counter pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (generic Advil, Motrin) and naproxen sodium (generic Aleve), can help reduce swelling and provide temporary pain relief. Prescription medication may be necessary to alleviate pain and swelling in patients with bunions caused by arthritis.

Medication for bunions

Your provider may prescribe the following medications for bunion:

Shoes for bunion

While it’s uncertain whether restrictive or ill-fitting shoes can cause bunions, they can certainly worsen pain and inflammation in existing bunions. If you have a bunion, it’s important that you find shoes that fit correctly in order to prevent your symptoms from worsening. It’s generally recommended^[23] that patients with bunions select footwear that can accommodate their feet without crowding. That means looking for shoes with broad toes and wide insteps and avoiding those that are too tight, too short, or sharply pointed. It’s also recommended that very high heels be avoided, as these put pressure on the front of the foot, increasing the risk of further problems or injury. If you have a bunion (or bunions), keep the following in mind when choosing a new pair of shoes:

• Have your feet measured regularly, as the size of your feet changes with age. Additionally, most people’s feet are not the same size. Purchase shoes that fit the larger foot best.
• Try on shoes at the end of the day, when your feet are their largest.
• Because sizing can vary drastically between different shoe styles and brands, select a shoe based on how it fits, rather than its numerical size.
• Try on shoes while standing, not sitting, and make sure you have adequate space between your longest toe and the tip of the shoe (about ⅜” to ½”).
• Make sure that the ball of your foot fits comfortably in the widest part of the shoe (called the ball pocket).
• Choose shoes that most closely conform to the shape of your foot to prevent friction and irritation. Don’t choose a pair that’s too tight with the expectation that it will eventually stretch and fit more comfortably.
• Walk around in a pair of shoes before purchasing to make sure that they fit well and don’t slip, rub, or pinch your feet.

With some trial and error, you’ll be able to find shoes that accommodate your bunions as comfortably as possible. Usually, you won’t have to sacrifice style to do so: many shoe brands offer comfortable options without being bulky or “boring.” There is also a wide variety of shoe brands made specifically for feet with bunions. Doing your research and finding high-quality, well-fitting shoes will pay off tremendously in the long run.

Bunion surgery

Severe bunions often require surgery^[24]. The goals of bunion surgery are twofold: reduce pain and correct as much deformity caused by the bunion as possible. Bunion surgery is not cosmetic: simply finding your bunion unsightly is usually not enough to warrant surgical treatment. Because bunion surgery is so intrusive and the recovery process so difficult, it is usually reserved for people whose bunions cause considerable pain and interfere with their daily lives. Different types of surgery are used to treat bunions, according to their severity:

• Mild bunion: This procedure involves shaving off the excess portion of bone and realigning the tendons, ligaments, and muscles surrounding the MTP joint. It may not, however, help correct the deformity that caused the bunion in the first place. Recovery from this surgery takes between three and four weeks and usually requires the patient to wear a postoperative shoe.
• Moderate bunion: This procedure is the same as that used for mild bunions, with the addition (depending on the severity of deformity) of an osteotomy (cutting) of the bone in order to shift it into the proper position. The bone is then held in place using pins or screws. Depending on the extent of the surgery, recovery can take between four and six weeks and may require a cast and crutches.
• Severe bunion: Surgery for severe bunions involves cutting away excess bone, as well as removing a wedge-shaped piece of bone from the metatarsal. The metatarsal is then realigned and secured with pins or screws. This procedure corrects misaligned tendons and ligaments as well as removing excess bone. Recovery usually takes between six and 12 weeks and may require a cast and crutches.
• Arthritic bunion/big toe joint: If a joint is beyond repairing with the above procedures (as is often the case in arthritis-related bunions), it may need to be fused. Fusing the joint causes the bones in the toe to heal together, eliminating movement (as well as pain). In some cases, an irreparable joint may be reconstructed using an artificial joint.

It can be difficult to determine the success of the results of bunion surgery. While some studies suggest that between 85% and 95%^[25] of patients are satisfied with the results of their surgeries, one review found that roughly one-third of patients were dissatisfied, despite improvements in pain and toe alignment. According to Harvard²⁵, this dissatisfaction may be the result of unrealistic expectations for the results of bunion surgery. While some patients believe that surgery will completely correct and straighten their bunions, allowing them to wear whatever shoes they’d like, this is not the case. Rather, bunion surgery can help improve misalignment and deformity. Along with the fact that bunion recurrence is reported in as much as 16% of cases, it’s important to keep in mind that bunion surgery does not promise perfection but improvement. You’ll likely work with your healthcare provider and surgeon or specialist to decide whether surgery is the best treatment option—and, if it is, which type of surgery is right for you. You’ll need to take into account a number of factors, such as recovery time, as well as the severity of your bunion.