Unexpected questions often come at medical providers. I cannot recall the specifics of the conversation that led up this particular question being posed, but it did circle around the main causes of a severe bunion deformity. We had confirmed that there were several members of her family who had similar deformities affecting their toes.

Some had gone through surgery while others had non-painful situations and that did not require the scalpel. I was about to delve into the genetic nature of numerous bone deformities when a long thoughtful pause preceded the earnest question, “Could someone catch a bunion from me?”

I paused to consider how to tactfully handle the situation.

“No. They are not infectious, but they sure can seem that way,” I answered.

Her question leads me to believe that many don't know why they have bumps which grow on the sides of their feet.

Bunions are a fairly common affliction of the first metatarsophalangeal joint of the foot. This area becomes deformed and painful when the first metatarsal deviates towards the arch of the foot and the big toe abuts the second toe. The most common situation that predisposes a person to the development of a bunion involves one of the more complex structures of the human foot. The dropping of your arch towards the floor is called pronation. Once your foot pronates to the floor, your big toe becomes unstable and can drift outwards at the ball of your foot because the forces which normally stabilize it are weakened from the dropped arch. That is the most common setting for a bunion to form. Other causes of a bunion include trauma, rheumatoid arthritis, and neuromuscular disorders.

Once formed, a bunion will continue to develop until the big toe abuts the second toe. The second toe regularly contracts out of the way allowing for an even greater deformity of the big toe to develop. In certain people the bunions are painful, even at the initial stages. Others will have severe bunions and not feel a single twinge of discomfort. I frequently check to see if there is some sort of pattern among close family members to determine how a developing bunion will behave.

There are a number of different things that could be causing your bunion to be painful. Sometimes a patient's shoe will contribute to the pain when the shoe's upper material causes pressure on the bone. The big toe can also rub against the second toe causing friction, blisters or pain. The second toe can even be the more painful area either at the ball of the foot or at its tip due to excessive loading at these points. Once appropriate shoes are used, the pain should decrease accordingly.

If the pain persists even with new shoes, then it should be seen in the office to further evaluate the source of the discomfort. Narrowing of the joint surfaces or even bone spurs may exist in this small joint creating pain. With bone spurs, pain is predominately positional in nature. Forcing the toe into extreme extension can reproduce pain. Missing cartilage creates bone-on-bone contact during these arthritic changes within the bunion deformity. In addition, there may be some nerve irritation along the bump itself. When light pressure along the skin of the bunion produces large amounts of electric shock-like pain, the small sensory nerves to the toe may be impinged.

Treatment is often aimed at padding, anti-inflammatories, shoes with a wider toe box and better arch supports. When these basic treatments fail it is time to look at injection and surgical treatments to remove the painful bunion deformity. Bunion injections involve a long-acting steroid into the joint itself or an inflamed bursa over the joint. If the injection fails to provide long-term relief or pain persists despite all other measures, then surgery should be discussed.

Bunion surgery involves the correction of the involved bone and/or soft tissue deformity present. The main goals are to provide a pain-free range of motion to the joint after surgery and maintain a rectus (or straight) alignment to the joint long term. Bunion surgery will often involve some sort of screw or pin to hold together the corrected shape of the bone. This fixation may or may not be kept in the toe for the rest of your life and you will never feel it within the bone once it has healed. Bunion surgery presents unique issues to a surgeon, since the operative area, at some point, must go back into regular use and be placed on the ground and walked upon constantly.

So, while bunions are not contagious, they can be painful. However, there are solutions, both surgical and non-surgical, that you can consider.

For more information, visit www.westsidepodiatrycenter.com.

Dr. Dan Smith is a podiatric physician at Westside Podiatry Center on 27 Fennell St., Skaneateles. He can be contacted at 685-3338