Good Medicine: Are Bunions Ruining Your Fall Foliage Hikes?

Hiking is a great way to enjoy the annual changing of the leaves. But for people with bunions, long walks can become excruciating. Understanding the cause of this common affliction, and learning how to care for it, may make autumn treks easier, and even pain-free.

Bunions develop when the first metatarsal bone of the foot splays outward, forcing the big toe to turn inward against neighboring toes. Over time, a bony bump, or bunion, forms at the base of the big toe joint. Clinicians call this deformity hallux valgus, Latin for “big toe turned away from the body’s midline.” One-third of American adults suffer with bunions — women twice as often as men.

Bunions often become red, swollen and painful. The joint may stiffen, making it difficult to walk and increasing the risk of falling. Untreated, bunions can lead to calluses, painful corns or hammertoes.

The exact cause of bunions is unknown, but the most likely factors include years of wearing tight, narrow shoes, inherited foot structure — 70% of sufferers have a biologic parent with bunions — and certain inflammatory conditions, like rheumatoid arthritis. Seniors over the age of 65 are at high risk for bunions; so are women and those who work all day on their feet.

If you have sore and aching bunions, see your medical provider, who will examine your feet. An X-ray is rarely necessary.

Treatment is initially conservative: Ice packs and foot elevation help acute symptoms, as does over-the-counter ibuprofen or acetaminophen, as directed by your clinician. Opt for wide shoes with a deep toe box to give your feet plenty of room — no narrow, pointed toes. Non-medicated self-adhesive pads will cushion the bunion; foot taping can alleviate discomfort. Your provider may recommend physical therapy to improve foot strength and flexibility, or prescribe orthotics — tailored shoe inserts that change pressure points and support the foot.

If you continue to have pain or your bunions interfere with daily activities, you may be referred to a podiatrist or orthopedist to discuss surgical treatment. The most common type of bunion surgery is an osteotomy: The metatarsal bone is broken and a pin is placed to realign your big toe joint. The length of recuperation depends on the nature of the procedure, but is generally about six weeks. Studies show that while osteotomies may significantly reduce pain, they only slightly improve function. Bunion surgery should never be used for cosmetic purposes.

Bunions are difficult to prevent, but wider, well-fitting footwear can help. Don’t buy shoes online: Try them on in person at the end of the day when your feet are naturally swollen (and bigger). There should be half-inch space between the tip of your longest toe and the end of the shoe. Choose flexible material, and look for good arch support; it is recommended that heels should be less than 2 inches high. Put on socks and walk in the shoes to make sure they don’t pinch or grab.

Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.