Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
The doctor considers a bunion as a possible diagnosis when noting
the
symptoms described above. The anatomy of the foot is
assessed
during the examination. Radiographs (X-ray films) of the
foot can be
helpful to determine the integrity of the joints of the foot
and to
screen for underlying conditions, such as arthritis or gout.
X-ray films are an excellent method of calculating the
alignment
of the toes.
How are bunions treated?
Nonsurgical treatments involve simply resting the foot by avoiding
excessive
walking and wearing loose (wider) shoes or sandals can often
relieve the irritating pain of bunions. Walking shoes may
have
some advantages, for example, over high-heeled styles that
tug
the big toe outward.
Anti-inflammation medications, such as
acetylsalicylic acid (Aspirin, Ecotrin),
ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever) and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation as
well as
pain. Local cold-pack application is sometimes helpful as
well.
To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes prescribed. A bunion splint is an orthotic device that is usually worn at night and can provide further relief. Depending on the structure of the foot, custom insoles might add further support and repositioning.
Any signs of skin breakdown or infection
can
require antibiotics.
When the measures above are effective in
relieving symptoms, patients should avoid irritating the
bunion
again by optimizing footwear and foot care.
For those whose bunions cause persisting pain, a surgical operation is considered for removal of the bunion. The surgical operation to remove a bunion is referred to as a bunionectomy. Surgical procedures can correct deformity and relieve pain leading to improved function. These procedures typically involve removing the bony growth of the bunion while realigning the big toe. Surgery is often, but not always, successful; failure to relieve pain can result from the big toe moving back to its previous deviated position even after surgery . However, proper footwear and activity restrictions can reduce the chances of surgical failure.
REFERENCE:
Klippel, John H., eds., et al. Primer on the Rheumatic Diseases, 13th ed. New York: Springer, 2008.
Diabetes-related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
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