Bunions and hammer fingers – a lopsided problem

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When every step is painful, aesthetics – although essential – takes a back seat. The foot, tortured for years, will sooner or later take revenge. Bunches and hammer fingers are punishments that await us for not respecting her right to freedom of movement.

A high heel causes uneven weight distribution, overloading the forefoot. Too narrow tip, on the other hand, causes a painful lump, called a bunion, to form on the first finger that is under constant pressure. The big toe, as it bends, overlaps the next ones and makes the next one curl under the foot.

Online forums where these ailments are discussed are bursting at the seams. There are so many entries that whoever would like to read them carefully would not be able to. Only women participate in the dialogue. Why? Because bunions, and we are talking about them, is a typically female condition. Statistics show that it is also very common. According to orthopedists, hallux valgus is a problem of over 80% of women. They can be dealt with at any age: they are afflicted by sixty-year-olds, as well as forty-year-olds, and sometimes even twenty-year-olds – the most important factor here is the severity of the ailments. Bunions, although initially treated only as an aesthetic problem, over time can cause a lot of pain and seriously limit our mobility.

Winne shoes and genes

“My first problems with bunions were when I was thirty. At first they didn’t hurt, just the more and more protruding ankle on my foot irritated me. However, I still wore high heels because my job required it. Today, at 55 years old, I have a problem wearing any elegant shoes. Everything that affects me causes great pain. I only put on sneakers or very loose shoes on my leg. Recently, even when I was lying in bed, my skin hurt on my bunions ”- complains Mrs. Barbara.

28-year-old Karolina is equally resentful. “My grandmother has bunions, and so does my mother. Apparently, this problem also occurred in the family earlier. Not wanting to have feet like them, I decided to give up heels and narrow toes. I rarely wear this type of footwear. But what if I see my feet slowly deforming and my bunion is getting more and more protruding? Soon I will have to give up wearing flip-flops because I don’t want to show anyone such unsightly feet, ”he says.

Both of these cases are typical and clearly indicate the causes of the bunion formation. The first is wearing the wrong footwear – high-heeled shoes with tapered toes. The second, rather independent of us, has a genetic basis. Predisposition to foot deformities can be passed down from generation to generation. However, these are not all the reasons for the formation of “bumps” on the head of the bones of the first finger. We should also mention here the relaxation of the muscles and ligaments of the foot and the flattening of the transverse arch, i.e. flat feet. Factors predisposing to the disease are also overweight and long hours of standing work.

What’s happening to the foot?

Wearing high heels and narrow toe shoes causes uneven weight distribution. The forefoot is then overloaded as the foot slowly slides off the heel. Then the transverse arch of the foot collapses and the so-called transverse flat feet. The fingers from the front and sides are under pressure, which gradually, but permanently, deforms their position. In this way, the big toe folds sideways, lifting the other finger upwards. From the medial side, at the level of the metatarsophalangeal joint, an additional bulge is formed on the head of the first metatarsal bone, which is an inflamed synovial bursa. Initially, it does not cause pain, but over time, due to constant irritation by narrow shoes, it becomes painfully inflamed. The area is constantly red and the skin is very delicate and sensitive to the slightest touch.

But that’s not all. Narrow footwear, as well as the bunions themselves, can also cause the formation of hammer toes that “curl” under the foot. The distortion mainly affects the second finger. His joint in a tight shoe is constantly bent and pushed upwards. Through constant contact with the footwear, a large, painful corns forms on its top.

As a result of all these distortions, the biomechanics of the foot changes – the strength of the structures stabilizing the foot deteriorates, the muscles weaken, and the toe can no longer play the role of a sufficiently strong point of support while walking. For this reason, other parts of the foot are overloaded, which also become deformed over time. Forming painful calluses may be an additional nuisance. As a consequence, not only is it impossible to find suitable footwear for such a deformed foot, but the same walking, even barefoot, becomes an activity that costs a lot of pain.

When the changes are minor

Advanced bunions do not form immediately. This is a long-term process that we can try to prevent. The truth, although very painful, is that if we are prone to this type of changes, even by following all the rules of orthopedics, we will not avoid the formation of hallux valgus. However, we can significantly slow down this process. In most cases, however, we treat all these foot deformities, bunions or hammer toes at our own request. So what to do? How to proceed effectively?

Internet forums are full of good advice – each new one is more and more sophisticated and, surprisingly, some people are said to help. According to orthopedists, all “grandma’s methods” can be put into fairy tales – they will not eliminate the bunions as such. Only pain or swelling can be reduced, although not in every case effectively, thanks to compresses of plantain or cabbage leaves. Doctors, however, recommend more medical ways to reduce the distortion:

• The first element of the therapy should be wearing shoes with a slight heel, with a wide front part.

• It is a good idea to regularly strengthen the muscles of the feet with exercises.

• Special orthopedic insoles made to measure can also be used to combat transverse flatfoot.

• It is a good idea to obtain appropriate corrective appliances in orthopedic stores. One – distance gel wedges – are inserted between the first and second fingers, which is to prevent overlapping of one on the other and reduce the toe deviation to the side. They can be worn in a shoe. The second – pads – worn only at night or during rest, are designed to keep the toe in the corrected position. In order to reduce discomfort while walking, special protectors, orthoses, filled with a polymer gel are used. They are available in several sizes and do not chafe the skin.

• With hammer fingers, you must use splitting wedges and “straight holders” – special rails that enclose the finger and keep it straight.

However, not in every case such therapy turns out to be effective. It is difficult to eliminate many years of bad habits and neglect in a short time. Besides, it often turns out that it is simply too late in the world. We are prompted to visit an orthopedist by pain that is difficult to bear and significant limitations in everyday functioning, and this means changes so advanced that “lighter” methods turn out to be fruitless.

The patient’s decision

When does surgery become a necessity? The opinion of orthopedists in this matter seems unambiguous. It depends on the person concerned. Some women decide to undergo surgery when the disease is not very advanced yet, wanting to enjoy shapely, undeformed feet for as long as possible. Others treat it as a last resort. According to Dr. Paweł Opaliński, MD, an orthopedic surgeon from IQ Medica, surgical intervention depends on the degree of toe deformity, duration of the disease, pain symptoms and other changes in the affected foot.

However, the decision on surgery is not easy. It is also hampered by opinions that, regardless of surgery, bunions have a tendency to recur. What it depends on? It is difficult to find an exact answer. According to Dr. Włodzimierz Ozonek from the Damian Medical Center in Warsaw with truly medical precision, there are 134 methods of operating on bunions (including the methods of Silver, Keller, Koczew, Mitchel, McBride, Mayo, and scarf). Each of the orthopedists specializes in one of them and considers it the best and most effective. Dr. Opaliński confirms: “The best method is one that the doctor masters perfectly. If someone knows how to operate and properly qualifies patients, he gets good results after surgery and permanent correction of foot deformities ”.

What are these treatments? Some, which are plastic of soft tissues (used mainly for small corrections), only eliminate the “tumor” protruding at the base of the big toe. Others are performed on hard tissues and concern not only the hallux itself, but also the correction of the metatarsal bones, as well as the elevation of the transverse arch of the foot. However, differences can also be noticed here. In some methods, in order to fix the bones, special plates or metal connectors are used, which are removed during the next operation after the foot fuses properly. However, not every procedure requires the use of such elements.

Rehabilitation and prices

Apart from the method of surgery, the recovery time is also important for patients. Again, it is difficult to find an unambiguous opinion among doctors. Some clinics say that you can walk in special footwear 2-3 days after the operation, and return to work within 3-4 weeks. Others admit that it takes a long time to return to full function. This is the opinion of Dr. Ozonek, who admits that after the operation on hard tissues, patients are put on a short plaster, immobilizing them for 2 weeks. It is necessary for proper bone fusion. After this time, the stitches are removed and another 2 weeks with plaster, but with a heel that allows you to move without putting any strain on the foot. However, as Dr. Ozonek claims, so that the work is not wasted, it is worth making some sacrifices.

The last point to consider, and for most of them very important, is the cost of the procedure. Yes, hallux valgus operations are performed in state hospitals and are then reimbursed by the National Health Fund. However, it should be remembered that not all centers have signed agreements with the Fund. In contrast, private clinics with state-of-the-art treatments demand a substantial fee for such a correction. In the case of hallux surgery only on soft tissues, the cost for one foot is approx. 2,9 thousand. PLN, in the case of two – approx. 4,2 thousand. zloty. If the procedure is performed on hard tissues (osteotomy, i.e. bone cutting), the prices oscillate around PLN 2,8 thousand. and 5 thousand zloty.

As in any case, making a decision is not easy – there are many dilemmas, questions multiply, and the arguments “for” are balanced with those “against”. One thing, as always, is for sure – it’s better to be safe than sorry. So, as far as possible, let’s do our best to keep the feet comfortable and thus prevent possible deformation of them.

Text: Marta Lenkiewicz

Consultation: Paweł Opaliński, MD, PhD, orthopedic surgeon, IQ MEDICA Plastic Surgery Center

Source: Let’s live longer

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