WebMD Medical News
Laura J. Martin, MD
Feb. 24, 2011 -- Bunions -- deformities at the base of the big toe that can cause pain and disability -- are common and can really slow a person down, a new study shows.
The study, which is published in Arthritis Care & Research, found that more than one in three older adults has at least one bunion, a hard bony bump that forms at the base of the big toe.
Bunions are thought to have a hereditary component in that they tend to run in some families. It has also been suggested that wearing shoes with elevated heels and a narrow toe-box may contribute to bunion development.
Study participants with bunions were more likely to experience pain in other parts of their body, including the hip, knee, low back, and foot. And those with the most severely deformed big toes, a condition known as hallux valgus, also had the poorest scores on measures of life quality, like social and physical functioning.
"Our findings indicate that hallux valgus is a significant and disabling musculoskeletal condition that affects overall quality of life," says Hylton Menz, an associate professor at La Trobe University in Melbourne, Australia, in a news release. "Interventions to correct or slow the progression of the deformity offer patients beneficial outcomes beyond merely localized pain relief."
For the study, researchers in the U.K. surveyed more than 2,800 people ages 56 and over.
Part of the survey included pictures of the left and right feet where the base of the big toe was progressively more deformed. Participants were asked to look at their own feet and pick the pictures that most closely resembled them. That helped researchers determine the severity of each person’s problem.
The study participants then were asked additional questions about their mental and physical health, pain intensity, concerns with personal appearance, and socioeconomic status and education level.
The study found that bunions were about twice as common in women as in men, and that the likelihood of having a bunion increased with age. Overall, about 28% of people ages 50 to 59 reported having bunions, compared to nearly 56% of people over age 80.
As the severity of the deformity increased, so too, did the problems associated with it.
Even after taking into account pain in other areas of the body, people with bunions still reported poorer mental and physical functioning than those without bunions.
Previous studies have shown that bunions may affect gait, balance, and increase risk of falls in older people, but researchers speculate that along with these issues, people with severe bunions may report less satisfaction with their lives because they have trouble finding shoes they like to wear.
So what can be done to prevent a bunion or keep it from getting worse?
“There are all kinds of splints and padding that you can put between your toes and things like that to try to prevent the toe from drifting over,” says Andrew J. Elliott, MD, a foot and ankle orthopaedic surgeon at the Hospital for Special Surgery in New York City.
However, he notes that previous studies have shown that up to 90% of people who get bunions report a family history, which may mean that some feet are just more susceptible to them than others.
“If it’s going to drift over, it’s going to do that, and it’s mostly because of an imbalance in the muscles as well as maybe some laxity in some ligaments that allow the bones to sort of drift in the direction that they’re going to, which is where it is going to rub up against the shoe,” Elliott says.
He says patients should consider surgery if they’re in steady pain, or if they’ve noticed their bunion getting rapidly worse in the last year. As a bunion gets worse, it may also cause hammertoes or crossover toes, or pain in the ball of the foot, called metatarsalgia.
“As the deformity gets bigger, it gets harder to get a good outcome with correction,” he says.
Correction typically involves surgery to cut the bone and move it over, but it doesn’t always fix things completely.
Up to 15% of people will still experience some discomfort in their feet after surgery, and up to one-third say they still can’t always wear the shoes they’d like to after the procedure, Elliott says.
And to add insult to injury, bunions can come back, even after surgery.
In the meantime, Elliott recommends reconsidering what’s on the shoe rack.
“You can make it a lot less painful by wearing appropriate footwear,” he says.
SOURCES:Menz, H. Arthritis Care & Research, March 2011.News release, Wiley.Andrew J. Elliott, MD, Hospital for Special Surgery, New York City.
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