Walking on eggshells

Taking care of your feet is an important part of staying healthy whatever your age, but it tends to become even more important for older people. A lifetime of exercise, activity and occasional abuse takes its toll on the feet and toes, and one of the most common ways your feet can be damaged in later life is through the formation of bunions.

Though bunions can develop at any stage in life, they are generally most common, and most severe, amongst elderly patients. However, there are a number of ways that the pain of a particularly troublesome bunion can be alleviated, and, in some cases, surgery can be used to provide a permanent and effective solution.

What is a bunion?

Put simply, a bunion is a bony growth that occurs within the joint at the base of the big toe. This outcrop of bone pushes outward, and becomes visible through the skin once large enough--the compressive action of this growth also tends to bend the big toe inwards, until it touches or even overlaps the second toe. A large bunion can be an intensely debilitating condition.

What causes bunions, and why are elderly people at more risk of developing them?

The exact processes that cause bunions to appear are still largely unknown; however, doctors and medical professionals have identified several causes that correlate with increased chance of bunion formation:

• Genetic predisposition - Bunions tend to run in the family, so if you have a family history of bunions your chances of developing them yourself are increased.
• Improper footwear - Shoes that are too tight can alter the mechanisms of the toe joints, potentially causing damage to the big toe joint that causes a bunion to form. Shoes that place pressure on the toe joints due to a narrow toe box are commonly associated with bunions.
• Pre-existing conditions - Some chronic conditions can increase the chances of bunions forming. Arthritic conditions, such as rheumatoid arthritis or osteoarthritis, are very commonly associated with bunions, as is gout.
• Hypermobility of the toe joint - If your big toes are unusually flexible, the joint is more likely to become damaged during hyperextension, promoting formation of bunions.

Since the chances of suffering from conditions such as arthritis and gout tend to increase with age, it's no surprise that elderly people tend to suffer more from bunions. However, even if you have perfectly healthy toe joints, bunions can still form in later life as a result of the natural ageing processes - as the muscles and tendons of the foot weaken and thin over the years, the big toe joint is left more exposed and vulnerable. Since the skin also thins as we age, a bunion on an elderly person's foot is also more likely to cause chafing and splitting of the skin over the swollen joint, exacerbating pain.

How can bunions in elderly people be treated?

If your bunion is painful and bothersome, but not especially debilitating, there are a number of palliative treatments available that can minimise the impact of a bunion without resorting to more invasive treatments:

• Bunion pads - These simple adhesive pads are applied directly to the bunion and stop the swollen joint rubbing and chafing against shoes and socks. They are cheap and readily available from any chemist, but they are only effective if applied properly and do not correct the underlying cause of a bunion in any way.
• Painkillers - Analgesic medication can be purchased over the counter, or prescribed by your doctor or podiatrist. Ibuprofen and other non-steroidal inflammatory drugs (NSAIDs) are generally used, as they also reduce inflammation around the toe joint. These medications are generally effective at reducing bunion pain, but can have side effects when taken for a long time. 
• Orthotic devices - These devices can be something as simple as a shaped insole for your shoe, or as complicated as a custom-fitted foot brace - your podiatrist will be able to advise you on which, if any, of the available choices is best for you. Orthotic devices can do a great deal to relieve pain and pressure on the bunion, and can also help you regain stability while walking and standing, if the bunion is affecting how you walk. However, they do very little to stop a bunion getting worse.
• Extra-wide footwear - Many specialist retailers offer wide shoes for elderly customers to relieve pressure on their bunions, but they can be expensive and not particularly flattering.

In more painful and debilitating cases, surgery may be required. Surgery, if successful, cures a toe joint of its bunion problem, but does not come without its fair share of risks. There are a number of surgical procedures available, depending on the severity of your condition, so consult a podiatrist, like those at McLean & Partners, on which they think is the best option.