Ask Dr. K: Proper shoe can help with bunion pain

DEAR DOCTOR K: I have a painful bunion. What is the best way to treat it?

DEAR READER: A bunion occurs when two bones in your foot no longer line up properly. Normally, a bone in the foot lines up straight with the first bone in your big toe. With a bunion, the joint where those two bones meet no longer is straight.

Instead, there’s knobby bone bulging outward at the base of your big toe. And the big toe itself turns inward, bending toward, or even under, the other toes. As a result, the knobby bone at the base of your big toe points outward.

Bunions are a common cause of painful toes. One cause of bunions is thought to be years of wearing shoes that squeeze the toes into pointed or narrow toe boxes, forcing the toes to fold over one another. Since women wear such shoes, and since bunions are more common in women than men, that seems reasonable.

On the other hand, plenty of my female patients wear shoes that should torture their toes – but they don’t all get bunions. And some of my male patients have bunions. There’s also pretty good evidence that bunions run in families. So I doubt we really know all the causes of bunions.

Over time, a bunion can become extremely painful. You can relieve the pain by padding the bunion with felt, moleskin or a doughnut-shaped pad. Hot and cold compresses may help. Or try stretching the bunion area of your shoe with a shoe stretcher.

NSAID pain relievers such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can also help relieve pain and inflammation.

If these steps don’t work, surgery can restore your toe to its normal position. The surgery is a safe procedure, but you can’t walk on the foot for several weeks, so your mobility is affected. To prevent bunions from developing, or to prevent an existing bunion from getting worse, wear shoes with roomy toe boxes. While shoes may not be the sole cause of bunions, they can aggravate the condition. Look for shoes with blunt toes rather than pointed ones. And allow for a quarter-inch to a half-inch of space between your longest toe and the front of the shoe.