Bunions Can Occur at Any Age

Feb. 8, 2001 -- Your grandmother wore ugly shoes because she had bunions. So it must be a problem only among the elderly, right? Not really true. Experts say that bunions, while aggravated by wearing tight shoes, generally are hereditary deformities that can be corrected by surgery -- but you have to do more than just remove the bump.

The word bunion comes from the Latin "bunio," meaning enlargement, and the medical term for the condition is "hallux valgus." About 10-25% of people have bunions, which can make your feet so sore that you can barely walk. It happens when the joint at the base of the big toe is misaligned and causes a bulge to form on the side of the foot.

Byron Hutchinson, DPM, says that anyone who has a predisposition to developing bunions or who has noticed that the condition is getting worse rapidly over a one-year period is a candidate for an operation.

"People have a common misconception that bunions are caused by shoes; they aren't. They are just aggravated by them," Hutchinson tells WebMD. "Unshod populations have the same numbers of people with bunions that we do. It's just that, because they aren't wearing shoes, it doesn't hurt until it becomes arthritic." Hutchinson is director of podiatric medical education at Franciscan Foot and Ankle Institute in Seattle. Podiatrists are doctors trained in treating conditions of the foot.

However, wearing narrow-toed or high-heeled shoes can make bunions worse, and more women than men tend to have the condition. In the U.S. and other shoe-wearing societies, people start noticing bunions in their 20s and 30s, he says. But it can start early.

"Kids can have bunions that look like an adult," explains Hutchinson, who will give a presentation on the subject tomorrow at the annual meeting of the American College of Foot and Ankle Surgeons. He recommends surgery for youngsters who show signs of developing severe bunions. However, he says it's best to wait until closure of growth plates -- the areas at the ends of the bones that continue to grow until a person reaches their maximum height.

Preventative measures can be used for some people, but because most cases are inherited, he recommends that for those with a predisposition for bunions, the condition be monitored annually using X-rays. When conservative measures, such as special shoes and pads, aren't halting progression of the deformity, he says surgery is the answer.

"You need to have surgery done before arthritis develops and before it's too late for new procedures to correct the problem," says Hutchinson, adding that just removing the bump won't do the trick. Anyone with a severe misalignment of the toe or indications that it is progressing rapidly to that end needs an operation that will correct the angle of the toe bones. This includes those who previously had surgery that did not correct the problem.

When surgery is done correctly, reoccurrence of the bunion is less than 5%, Hutchinson says.

The surgery includes cutting and realigning the bone and correcting alignment of adjacent ligaments and tendons. If the joint already is arthritic, meaning that the cartilage has deteriorated, then the joint probably will have to be replaced with an artificial one or it will have to be fused, experts say.

Scott Ashton, DPM, a podiatrist at Medical City Dallas Hospital, agrees that just removing the bump is only cosmetic.

"A bunion is caused by an increase in the angle between the two lower bones of the big toe," Ashton tells WebMD. Surgery is definitely called for if the angle between the toe bones is more than 12%, and he often sees patients whose angle has reached 18-20%.

"The key to correction is to close the joint angle to less than 8%," Ashton says. From a technical standpoint, he believes anyone can have the surgery unless they have major health problems, for instance, "soft bones" or some other condition that would make it difficult to recover and go through rehabilitation. He has done surgery for people as young as 11.

"From a strictly technical standpoint, it can be done on any age," he says. But he cautions that in the case of a youngster, care must be taken not to disturb the growth plates.

If your big toe is angling toward your other toes and you are having pain in the area of the joint, you should ask your doctor to recommend a podiatrist who is board certified in foot surgery or an orthopaedist who has done a fellowship in that specialty.