High Heels and Bunions - Symptoms, Diagnosis, and Treatment

Introduction

High heels are a popular fashion item for many women, but they have also been linked to the development of bunions. Bunions are bony protuberances that form at the base of the big toe’s joint. They can be painful and can make it difficult for a person to walk or wear certain shoes.

What Are Bunions?

Bunions, also known as hallus abducto valgus, are common foot deformity that occurs when the big toe joint becomes enlarged and misaligned. It is commonly found on the big toe’s joint (metatarsophalangeal joint). Bunions are a more common foot condition in women compared to men, likely due to the weaker connective tissue in their feet and a greater tendency to wear tight-fitting, high-heeled footwear. According to estimates, approximately one in three individuals aged 65 and above have some degree of bunion.

Do High Heels Cause Bunions?

High heels have been linked to bunions because they put extra pressure on the front of the foot, causing the big toe to be pushed out of alignment. When this happens, the joint at the base of the big toe can become enlarged, and a bunion can form over time. High heels also cause the foot to slide forward in the shoe, which can put additional stress on the big toe joint.

What Are Other Factors Causing Bunions?

• Genetics: Some people are more prone to developing bunions due to inherited foot structures that make them more susceptible to the condition. If someone in the family has bunions, they may be more likely to develop them as well.

• Foot Deformity: People with certain foot mechanics, such as high arches or flat feet, are more likely to develop bunions. These foot types can cause abnormal stress and pressure on the big toe joint, leading to the formation of a bunion.

• Prolonged Wearing of Tight, Narrow Shoes: Wearing shoes that are too tight or have a narrow toe box can put pressure on the big toe, pushing it towards the other toes. This can lead to the formation of a bunion over time.

• Medical Conditions: Certain medical conditions, such as rheumatoid arthritis, can increase the risk of developing bunions by causing inflammation and weakening of the joints and ligaments in the feet.

• Trauma: Trauma or injury to the big toe joint can also lead to the development of a bunion.

• Occupational Hazard: Certain occupations that require prolonged standing or walking on hard surfaces can also increase the risk of developing a bunion.

What Are the Symptoms of Bunions?

The symptoms of bunions can include the following.

• Pain or Discomfort: Bunions can cause pain or discomfort in the affected joint, especially when wearing tight or ill-fitting shoes. The pain may also be present at the side of the big toe or at the ball of the foot.

• Swelling or Redness: The joint at the base of the big toe can become swollen or red, and the skin over the bunion may be irritated or tender to the touch.

• Bending of the Big Toe: In advanced cases, the big toe may start to bend towards the other toes, making it difficult to walk or wear shoes.

• Calluses and Corns: Bunions can cause calluses or corns to develop on the side or bottom of the big toe or between the big toe and the second toe.

• Limited Movement of the Big Toe: The big toe may become stiff and limited in its range of motion, making it difficult to walk or move the foot.

• Changes in Shoe Fit: Bunions can cause shoes to feel tight or uncomfortable, especially around the toe area.

How Can Bunions Be Diagnosed?

Bunions can be diagnosed with the help of medical history, physical examination, and imaging tests. The doctor will first inquire about the patient's medical history, overall health, and any symptoms they may be experiencing. This information will help the doctor get a better understanding of the patient's overall health and any potential underlying conditions that may be contributing to the bunion.

Physical Examination:

• The doctor will perform a thorough examination of the affected foot. This will involve inspecting the foot for any visible signs of a bunion, such as a bony protrusion on the joint at the base of the big toe or a change in the shape of the toe. The doctor will also check for any redness, swelling, or tenderness in the area.

Imaging Techniques:

• In addition to the physical examination, the doctor may also order an X-ray. X-rays use electromagnetic waves to produce images of dense structures, such as bone.

• This test will allow the doctor to see the alignment of the toes and look for damage to the metatarsophalangeal (MTP) joint, which is present at the bottom of the big toe.

• The alignment of the foot bones changes when the patient stands or sits, so the X-ray will be taken while the patient is standing for better visibility of the misalignment of the foot bones.

• The X-ray will also help the doctor determine whether there is arthritis associated with the bunion. Arthritis is a long-lasting condition that causes inflammation and damage to the joints, and it can occur in the MTP joint in cases of bunions.

Overall, the physical examination and X-ray are done together to better understand the condition and decide the best treatment plan.

How Are Bunions Treated?

Bunions can be treated in various ways based on the severity of the condition and the individual's symptoms. A minor bunion may be treated with non-surgical methods such as padding and shoe inserts, while a more severe bunion may require surgery. Conservative treatment options include:

• Wearing Appropriate Shoes: Bunions can be caused or made worse by wearing shoes that are too tight or have a narrow toe box. Wearing shoes with enough space for a toe box and low heels can help reduce pressure on the bunion and relieve pain and discomfort. It's recommended to avoid high heels and pointed toes shoes.

• Using Over-The-Counter Pain Relievers: Pain relievers such as Acetaminophen (paracetamol) or Ibuprofen can help reduce pain and inflammation associated with bunions.

• Applying Ice Packs: Ice packs applied over the bunion can help reduce pain and inflammation by constricting blood vessels and numbing the area. Apply ice packs for around 20 minutes several times a day.

• Bunion Pads or Splints: Using bunion pads or splints can be placed inside the shoe to help realign the toe and reduce pressure on the bunion. They can also help to alleviate pain and discomfort.

• Stretching Exercises: Stretching exercises can help keep the toes flexible and improve the range of motion.

When Is Surgery Considered?

Surgery may be considered if the conservative methods are ineffective or if the bunion is severe. The surgical procedure will be determined based on the individual's specific condition. Some common types of bunion surgery include:

• Bunionectomy: This is the common type of bunion surgery. It involves removing the bony protrusion and realigning the bones of the big toe.

• Osteotomy: It is a procedure that involves cutting and repositioning the bones of the big toe to correct the deformity.

• Arthrodesis: This procedure involves fusing the joint at the base of the big toe to correct the deformity and reduce pain.

Conclusion

High heels can be a contributing factor in the development of this foot deformity. Wearing high heels in moderation, choosing shoes that fit correctly, and having a wide toe box is essential to prevent the risk of bunions. If the patient experiences pain or discomfort in the big toe joint, it is better to consult with a podiatrist or an orthopedic surgeon for further evaluation. The healthcare practitioner will consider factors like severity, symptoms, and other medical conditions to determine the best course of treatment.