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Give bunions the boot!

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Bunion. (Photo: Getty/Gallo Images)
Bunion. (Photo: Getty/Gallo Images)

For as she can remember, the bumps next to her big toes have been an unsightly nuisance.

Lelani Oosthuizen (39) has always adored fashionable footwear, especially high heels, and she took pride in her neatly groomed feet. If only her horrible bunions didn’t spoil the picture. 

Even though they felt uncomfortable and

 didn’t look great, the bumps on the sides of her feet initially didn’t seem to be a serious problem for the mom of two.

But over the years she watched helplessly as the knobs grew larger, eventually making her big toes turn inwards.

The legal secretary from Wynberg, Cape Town, recalls her embarrassment.

“They were obvious for everyone to see. One Christmas my mom, who also has bunions, asked very politely if I’d wear socks so our relatives wouldn’t have to look at them. When my friends were all wearing lovely sandals I couldn’t because the straps wouldn’t fit the strange shape of my feet.” Two years ago the bunions suddenly became red and painful.

“Some days they’d just be sore, but other days I couldn’t get my feet into any kind of shoe,” Lelani tells us. One day she wasn’t able to move at all without experiencing sharp pains in her feet. That’s when she realised she needed help.

She made an appointment with a podiatrist and after the consultation and two X-rays was told that if she wanted to walk normally again, without pain, foot surgery was her only option.

And it turned out to be the solution – since her surgery in 2016, Lelani’s problems with her feet have become a thing of the past.

“Now I love showing off my feet and wearing fashionable sandals,” she says. “It’s wonderful to be standing, walking and dancing like a normal person. And beauty therapists don’t get a fright when I go for a pedicure.”

Why do some people get bunions?

A bunion is a bony bump that forms at the base of the big toe, resulting in a deformity of the joint connecting the big toe to the foot.

Often the big toe leans towards the second toe as the joint presses outwards. The tissue around the bunion can become quite red and painful, Cape Town podiatrist Christian Olivier says.

Bunions have various causes, says Johannesburg podiatrist Cherie Viljoen, but genetics and ill-fitting shoes are the most common culprits.

Some people – both men and women can develop bunions – are born with a genetic bone disorder or a tendon deformity that makes them more susceptible to bunions and they can do nothing to escape the problem, says Dr Jason Crane, an orthopaedic surgeon from Cape Town.

But people who don’t have this genetic problem can also develop bunions. In fact, shoes that are too narrow across the toes are the most common cause, which is why women are more likely than men to develop bunions.

People who spend a lot of time on their feet at work, such as teachers and nurses, are also more prone to bunions.

Women can develop them during pregnancy due to hormonal changes that cause the ligaments to lose tension and make the feet flatter. Bunions are also associated with arthritis, which affects the cartilage in the joints.

A bunion can develop over years or very quickly, even in a matter of weeks, Olivier says. Once you have it, it doesn’t go away on its own. It can stay the same size but it won’t disappear or get smaller. It may grow larger and the only way to get rid of it is with  surgery.

“Bunions can be completely painless, or be painful just every now and then, often because of wearing the wrong shoes,” Crane says.

“Shoes that restrict the movement of your toes are the biggest cause of pain,” Olivier says.

“They can irritate the soft tissue around the bunion and cause inflammation, which can make the skin red, shiny and hot. The pain you feel isn’t from the bone but because of inflammation of the soft tissue.” Eventually it can become impossible to wear high heels due to the pain and discomfort, Crane says.

In fact, it can become almost too painful to walk. A podiatrist can help you choose the correct shoes so your bunions don’t get worse and to keep pain at bay.

But if these measures don’t help, surgery is the only way out, Olivier says.

What can be done about them?

“It’s best to see a podiatrist, whether you have pain or not. The podiatrist will be able to determine the cause and suggest treatment,” Viljoen says.

“Treatment generally starts with comfortable shoes,” Crane says. “This won’t make the bunions smaller, but they reduce pressure on the foot bones and so relieve pain and stop the bunions from getting worse.

“In the early stages, anti-inflammatory medication or a cortisone injection can be administered for pain relief.”

Treatment by a podiatrist may also include orthopaedic devices to reduce pressure and relieve pain, Viljoen adds.

“If the bunion is constantly painful, movement of your big toe is restricted and you can no longer wear even wide, comfortable shoes, you should consider surgery,” Crane says. “It’s never too late.”

What the operation entails

Besides removing the bunion, the surgeon may also make other repairs to your foot. The procedure depends on the shape and size of the bunion, among other factors, and these will also determine the cost.

But a rough estimate is between R30 000 and R40 000 for the procedure and theatre costs at a private hospital.

The surgery could involve just removal of the bony bump and a simple realignment of the big toe joint, but it may also be necessary to remove a small portion of bone and sometimes the joint has to be kept in place with pins, screws, wires and plates.

In certain cases it’s not only the big toe that’s operated on, Olivier says – the other toes and bones of the foot may also have to be realigned. He cautions that the surgery is extremely painful.

“Sometimes surgeons operate on both feet at the same time because the pain can be so severe that patients don’t come back for the operation on the other foot.

“There’s also a long recovery process that can last three to six months,” he says. “Generally, for six to 12 weeks after the operation patients can’t use their foot or feet. So it has to be planned well. And even if the operation is a success, there’s always a chance the bunions can grow back.” Lelani admits it was painful but she has no regrets.

“If you decide to have the operation, you must realise it’s a long and painful process. I had my right foot operated on first and my left foot four weeks later. So three months went by from the first op until the last stitches were removed.” Failed procedures have given bunion surgery a poor reputation, Crane says. 

“But if the operation is done by an experienced surgeon with a proven track record, it can be life-changing.”

Many patients are able to go back to wearing heels afterwards, he says. Lelani isn’t taking any chances though. “I’ve put my heels in storage for the moment.”

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