From the Guidelines
Treatment for a bunion should begin with conservative approaches, prioritizing well-fitted walking shoes or athletic shoes that cushion the feet and redistribute pressure, as recommended by the most recent guidelines 1. The goal of treatment is to reduce pressure on the bunion, alleviate pain, and prevent further complications.
- Key considerations include:
- Wearing wide, comfortable shoes with a roomy toe box to reduce pressure on the bunion
- Using over-the-counter pain relievers like ibuprofen or naproxen to manage pain and inflammation
- Applying ice packs to reduce swelling
- Utilizing bunion pads or custom orthotics to cushion the protrusion and distribute pressure evenly
- According to the latest guidelines 1, people with bony deformities, including bunions, may need extra wide or deep shoes, and those who cannot be accommodated with commercial therapeutic footwear may require custom-molded shoes.
- It is essential to note that the routine prescription of therapeutic footwear is not generally recommended, but patients should be provided with adequate information to aid in selecting appropriate footwear 1.
- Surgery, such as bunionectomy, may be considered when conservative treatments fail and pain significantly impacts daily activities.
- The importance of early diagnosis and treatment of related conditions, such as Charcot neuroarthropathy, cannot be overstated, as it can help prevent deformities that increase the risk of ulceration and amputation 1.
From the Research
Treatment Options for Bunions
- Initial treatment of symptomatic bunions should be non-operative, including accommodative footwear, nonsteroidal anti-inflammatory drugs, orthotics, splints/braces, and toe spacers 2
- These non-operative treatments may not provide long-term relief, and referral to an orthopaedic surgeon is recommended if the patient has a painful prominence and has exhausted non-operative treatment 2
- Surgical management is often necessary when conservative management fails, with over 150 procedures described, including minimally invasive approaches 3
- Minimally invasive percutaneous methods of bunion correction have shown positive outcomes, and can be considered as an alternative to traditional open approaches 3
Conservative Management
- Weak muscles may play a role in bunion-related pain and movement problems, and muscle-strengthening exercises may help people with bunions 4
- Nonsurgical management is usually effective for symptomatic bunionettes, including friction reduction and soft-tissue balance restoration 5
- Accommodative footwear and orthotics can help reduce pressure and friction on the affected area, alleviating pain and discomfort 2, 5
Surgical Intervention
- Surgical options are available for bunion correction, including minimally invasive approaches, and can be considered when nonsurgical treatment fails 3, 5
- Smoking is a relative contraindication to surgery, and cessation is recommended before undergoing surgical intervention 2
- Cosmesis alone is not an indication for operative management, and surgery should only be considered for patients with painful prominences or significant deformity 2