By Dr. Jackie Sutera

 

What Are Bunions?

A bunion (hallux valgus) is a bony prominence that develops on the base of the big toe joint. The big toe pulls toward the smaller ones. In turn, the joint at the base of the toe protrudes out in the opposite direction.  Bunions can be hereditary and tend to run in families, but some shoes, injuries, and activities over time can encourage and expedite formation.

 

The bony protrusion can oftentimes become inflamed. Discomforts associated with bunions range from redness and mild soreness to swelling, persistent tenderness, and severe foot pain. Some people also have a difficult time moving their toes and the joint can become arthritic. Foot stress, genetics, foot deformities, and certain medical conditions all can make this condition worse. Bunions are very rarely something people are born with, though some may be predisposed to developing the deformity later in life.

 

I recommend a visit to your podiatrist for X Rays, which will confirm if you have a bunion. This will also allow your doctor to evaluate the severity and recommend a proper individualized treatment plan.

 

Symptoms of bunions include:

• Swelling at the base (bottom joint) of the big toe
• Redness at the base of the big toe
• A sore, persistently tender bump on one or both feet
• Corns and calluses between the toes
• Limited movement or inability to move the big toe
• Trouble fitting into shoes
• Pain when walking or standing

 

If you’re experiencing ongoing pain and are unable to move your big toe or flex your foot, it’s probably best to check in with your podiatrist.

 

Though most bunions don’t require medical treatment, your provider might suggest prescription orthotics or over-the-counter shoe inserts. They can make recommendations about footwear and lifestyle changes as well.

 

Unfortunately, bunions are not reversible and the only way to get rid of a bunion entirely is with surgical correction which involves either removing the bump or cutting and realigning the joint. However, there are various conservative treatments that can help you manage bunion pain and prevent the deformity from getting worse.

 

Treating and managing bunions can involve:

• Over-the-counter bunion pads to cushion the bump
• Medical tape to help align the toe joints
• Custom-made or over-the-counter orthotic shoe inserts
• Physical therapy and massage to break up the soft tissue and encourage toe mobility
• Injection therapy
• Stretching and strengthening moves for the toes
• Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin and ibuprofen to reduce inflammation, swelling, and pain
• Icing and elevating the feet
• Switching to wider, more supportive footwear

 

For many people, footwear changes are the first and most effective course of action.

 

The Best Shoes for Bunions

Properly fitting footwear is crucial in preventing bunions from forming and stopping an existing protrusion from getting worse. Make sure you wear the proper shoe size in terms of both length and width to accommodate for a wider foot, caused by the bunion.

 

Vionic has shoes designed to feel comfortable even if you have bunions, including wide widths and styles with adjustable uppers. Each pair is biomechanically engineered with built-in orthotics. You can count on arch support, roomy toe boxes, and durable, shock-absorbing outsoles that take pressure off your joints.

 

In addition to dress shoes, boots, slippers, flats, wedges, and sneakers, Vionic carries fashion-forward orthotic sandals for bunions. They also offer orthotics for men and women, which can go in virtually any closed-toe shoe in place of factory inserts. 

 

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Hammer Toes

Hammer toes are raised circular bumps that appear on the knuckles of toes. They are ultimately caused by an imbalance of the small muscles, tendons, and ligaments that keep the toe straight.  A hammer toe occurs when one or both toe joints bend downward and most commonly occurs to the 4 smaller toes, often sparing the great toe.  

 

A hammer toe usually causes pain in closed shoes  and can make walking difficult.  They can be painful when you try to stretch, bend or flex the toe as well.  Sometimes a hard callus build up of dead skin can develop on top of the toe called a corn. There also may be swelling, redness or a burning sensation on top or in between the toes. These outward changes seen on the toe develop due to friction between the top of the toe and inside the toe box of the shoe . A podiatrist usually can diagnose a hammer toe during clinical examination. X Rays are routinely performed to help determine how rigid or flexible the hammer toe is and visualize arthritic changes or spurring.

 

What Causes Hammer Toe? 

A very common cause of this condition occurs from imbalances resulting from foot structure, such as when the second toe is longer than the great toe. Longer toes tend to jam into the toe box while walking and running and eventually will cause hammering. Hammer toes may also run in families and can be associated with aging. Injuries, such as broken, stubbed or jammed toes may be more likely to develop hammertoe contractures from damage to the joints. People with flat feet, high arch feet and diseases such as arthritis, diabetes and certain neurological conditions are also more prone to develop hammer toes as well.  

 

Hammer toes usually develop over time, is a progressive condition and many are thought to be caused by ill fitting shoes such as pointed heels. Over use of  tight shoes or high heeled shoes for long periods of time, and long periods of standing and walking in heels can cause the toes to become bent and contracted. Women are more likely to develop hammer toes, largely to the shoes they wear.  

 

What Are The Types Of Hammer Toes?

There are different types of hammer toes. Some hammer toes can be flexible, while others are more rigid. If the toe can be moved at the joint into a straight position that is a good sign and there are some helpful non surgical treatment options.  Conservative treatments such as shoe gear changes, padding, cushioning, and orthotics are often initially recommended. Having your podiatrist shave down, or inject cortisone into an associated painful corn can also give immediate relief. Icing, strengthening and stretching exercises may also be prescribed when the hammer toe is flexible. 

 

When the toe progresses from flexible to rigid and it cannot be moved into a straight position,  conservative measures are less likely to work. Many of these patients may require hammer toe surgery where a small bony portion of the contracted joint is removed in order to straighten the toe. This is routinely performed on an outpatient basis at a surgical center or hospital and has a recovery period of  approximately 3 weeks.

 

Hammer toes have a hereditary component but also get worse due to shoes, and activity.  

 

Tips for preventing hammer toes: 

• Do your best to make sure the fit of the toe box matches the shape of your foot. Avoid narrow, pointy and tight shoes if you have hammer toes or a wide and square shaped foot. 
• Alternate and switch between heels and flats throughout the day as necessary. Heels are not walking shoes and should not be used for long periods of standing or walking. 
• Also, switch throughout the week. Have a “shoe wardrobe”, a variety of different types.  
• After wearing heels or doing high impact exercise- stretch and massage your toes. Do toe grip exercises to keep your toe muscles strong, and limber. Use your toes to grab a towel or small object. Hold for 15 seconds and let go. Repeat 12 times daily. 

 

What type of shoes should people with hammer toes look for/wear (both open and closed-toe shoes)?  Best for hammer toes would be round, soft or open toe boxed shoes.

 

Managing hammer toe pain:

• Over-the-counter hammer toe pads to cushion the bumps and corns
• Custom-made or over-the-counter orthotic shoe inserts
• Physical therapy and massage to encourage toe mobility
• Injection therapy
• Stretching and strengthening exercises for the toes
• Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin and ibuprofen to reduce inflammation, swelling, and pain
• Icing and elevating the feet
• Switching to wider, more supportive footwear

 

About the author: 

Dr. Jacqueline Sutera is a surgically trained doctor of podiatric medicine specializing in the prevention and treatment of foot pathology. She graduated from Fordham University with a Bachelor of Science degree in Biology and Philosophy. She later attended the New York College of Podiatric Medicine where she earned the degree of Doctor of Podiatric Medicine (DPM). Dr. Sutera received her postgraduate residency training at the busy level-one trauma center at Jamaica Hospital in Queens, NY and Brookdale Hospital in Brooklyn, NY. During her time there, she served as chief surgical resident and received and completed training in all aspects of podiatric medicine and surgery. Dr. Sutera is Board Certified in Foot Surgery and is a Fellow of the American College of Foot & Ankle Surgeons. She is also a proud member and spokesperson for the American Podiatric Medical Association and the New York State Podiatric Medical Society. As one of NYC’s premier podiatric physicians, she is a caring, conscientious and extremely personable doctor who prides herself on being holistic in her approach to foot care. Where other doctors treat feet only locally, she has a unique gift of being able to link some foot problems to other underlying conditions taking place in the body.