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Bunions and Hammertoes: An Uncomfortable Relationship: How to relieve and possibly avoid these common foot problems.

Often painful and unsightly, bunions are the bane of more women than men. These boney maladies typically run in families, but they also occur in people who are "hypermobile," meaning too flexible. Having an inflammatory condition, such as rheumatoid arthritis, can cause also bunions. And finally, the overwhelming culprit: shoes. In particular, wearing overly tight and pointy shoes, such as pumps with high heels, can cause and exacerbate the bone shifting that results in a bunion.

"The bone on the inside of your foot starts to move inward," explains UCLA orthopaedic surgeon Joan Williams, MD. "Over time, tissues stretch out and you see a big bump on the outside of your foot. That can press on your second toe, which also can cause a problem."

That problem is hammertoes. The toes start to curl and lift, which can then rub against the top of shoes. Before you think you're destined to wear only flip-flops, there are some at-home approaches that can help both these common foot problems.

Adjusting to the Change

Over-the-counter pads and splints provide padding and can pull the big toe back into alignment somewhat. This won't fix the problem, but it can help slow down the progression of it. Corn pads, toe spacers (like those used in pedicures), and applying ice to a bunion can relieve swelling, as can NSAIDs, such as ibuprofen and naproxen.

While pain will keep many people out of high heels, even if the bunion doesn't hurt, it's best to avoid wearing high heels and shoes with pointed toes, because that can only worsen the problem. Instead, choose breathable shoes with a wider toe box and plenty of cushion. Beware, however, of shoes with thick treads, as these can be tripping hazards, especially on carpeting.

Finally, there are toe and foot exercises that can help bring more circulation and mobility to your toes. See the towel curl example below. Because everyone's foot issues are different, a physical therapist can recommend the most effective exercises for you.

Surgical Interventions

As a bunion bump gets worse, it can be filled with fluid and extra bone, which is often quite painful. If pain persists despite changes in footwear and other interventions, or if you have difficulty walking because of bunions and hammertoes, surgery may help. There's a spectrum of surgical options for both hammertoes and bunions. It all depends on the degree of deformity. Osteotomies refer to cutting and re-aligning the bone, whereas soft tissue procedures tighten or release tissues. Often both these procedures are done together.

"The biggest risks of any surgery on the foot are infection and nerve injury," says Dr. Williams. "Functionally there should not be any limitations after surgery, although most patients should be aware that when a hammertoe is fixed, that toe will no longer be able to be curled like the other toes."

Post-surgical recovery can take anywhere from six week to six months. Full recovery can take up to a year. While the surgery can be successful, Dr. Williams says there is risk of recurrence of the bunion or hammertoe deformity.

To find a qualified surgeon, consult with those who commonly perform these procedures. For more information, check out Dr. Williams' UCLA MD Webchat on YouTube at https://tinyurl.com/y7lsxv9f.

WHAT YOU CAN DO

* Avoid wearing narrow and high-heeled shoes.

* Wear shoes with a wide toe box.

* Relieve swollen bunions with ice and/or NSAIDs.

* Try over-the-counter pads and splints.

TOWEL CURLS (You should feel this exercise at the top of your foot and your toes.)

Repetitions: 5

Days per week: Daily

Main muscles worked: Plantar flexors

Equipment needed: Hand towel

Step-by-step directions:

* Sit with both feet flat and place a small towel on the floor in front of you.

* Grab the center of the towel with your toes and curl the towel toward you.

* Relax and repeat.

Tip: You can make this exercise more challenging by placing a weight on the edge of the towel.

SOURCE: American Academy of Orthopaedic Surgeons. http://orthointo.aaos.org/topic.cfm?topic=a00667
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Title Annotation:BONES & JOINTS
Publication:Healthy Years
Date:Nov 1, 2017
Words:672
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