Bottom Line/HEALTH:Do you have a painful bulge on the side of your foot? It may be more than just a bulge—it may be a bunion. So here’s what you need to know.

I’m Sarah Hiner, president of Bottom Line Publications, and these are our Conversations With the Experts, where we get the answers to your tough questions from our leading experts.

Today we’re talking to Dr. Johanna Youner, who’s a leading podiatrist and foot surgeon in private practice in New York City. Welcome, Dr. Youner.

Dr. Johanna Youner:Thank you, Sarah. I’m happy to be here.
Bottom Line: What is a bunion versus what is just a bump?
Dr. Youner:A bunion is a painful enlargement on the side of the foot at the great toe, and you know you have it when you look down and see the bunion or all of a sudden your feet start to hurt for no reason. It’s generally your bunion.
Bottom Line: So we have a picture right up there. That little red spot on the top, that’s the bones—is it the bones sticking out? What’s happening?
Dr. Youner: It’s a multifactorial problem. It’s usually the start of the bone sticking out. It can be from the wrong shoes…it can be an inherited problem…but the bone starts to rub against the shoe and the area gets inflamed, then all hell breaks loose and you can’t walk.
Bottom Line:Do they have to hurt?
Dr. Youner:They don’t have to hurt…and the only time you really need to seek surgical attention is if the bunion hurts.
Bottom Line:When I was doing my research on this, they seem to skew female. Why is that?
Dr. Youner:Yes. Because of shoes. Women wear shoes that look like bunions. If you look at a woman’s shoe, if it’s pointed, it will be forcing the foot into a bunion position. The big toe joint will be forced out, with the big toe forced in—creating a triangle at the end of the foot. Feet are square. They shouldn’t be forced into shoes like that.
Bottom Line: Given the fact that people have all sorts of weird foot shapes, how do you know whether it’s a bunion or it’s just a weird foot shape?
Dr. Youner:A weird foot shape—it can be a long, skinny foot…a square foot. A bunion will be a noticeable enlargement. And if it’s painful, you can be sure it’s not a normal variant.
Bottom Line:So how about if it just sticks out a little? I have a daughter who is a dancer, and it’s just kind of starting to stick out a little bit. But she’s not in pain, but it triangulates a little.
Dr. Youner:It probably is a bunion, because she has used her feet far more than most young ladies if she’s been dancing.
Bottom Line:So let’s look at some bunions. Let’s see good, bad, ugly, OK? How’s this one? This is a generic bunion, some pretty pink toes.
Dr. Youner:This is a bunion. This is quite a big bunion. You can see the enlargement there, and that foot may not be painful, but it may be difficult for this young lady to fit her foot into a shoe. For her to want to address this, if this young lady is having pain, it’s a good time to see the doctor and even use something as simple as an arch support. So this can be helped. We cannot reduce the size of a bunion unless we do surgery, but we can take the pain away with supports.
Bottom Line:Should somebody start to go for treatment as soon as they start to see a bunion forming?
Dr. Youner:Yes, absolutely. They should be evaluated.
Bottom Line: Let’s look at another picture. This was amazing to me—celebrities have the worst feet. Victoria Beckham. What do you have to say about her bunion?
Dr. Youner:On the left—the left foot is usually the worse foot in people. The left foot has quite a severe bunion, and in this, you can actually see the big toe is tilted up. It’s quite severe. And this may be because she wears shoes that force the foot into a bunion shape.
Bottom Line:When you have a bunion that looks like that, how does she even get that foot into a shoe?
Dr. Youner:She may not very comfortably get that foot into a shoe, but she has to project a certain image, so she does have to wear a high heel.
Bottom Line:All right, let’s look at another foot. And this foot actually is Naomi Campbell. Again, it’s amazing—some of the most beautiful models on earth, and they have got some pretty bad-looking feet.
Dr. Youner:I think we call this a fashion victim. This foot, especially the left foot, is the foot that usually takes the brunt of the weight and wear and tear. This foot is having a lot of trouble fitting into a four-inch or five-inch heel. The foot is not meant to do this. The deforming forces on the foot from a four- or five-inch heel have created this bunion or worsened a natural tendency.
Bottom Line:So when people have bunions like that—I mean, these are some pretty bad examples—must they get treated? Because frankly, I’m shocked. These women have all the resources and all the money in the world, but they’re walking around with bunions.
Dr. Youner:Bunions aren’t something that’s so simple to treat. To fix a bunion perfectly requires bony surgery. If you need to cut your bone to fix your foot, you’re going to be out of commission for several months.

So it needs to be looked at, and you need to make sure you look at every factor—your shoes, your arch supports, what you’re doing, what kind of work you do. If you stand, maybe you should be at more of a seated job. If you have pain, there are other things that can be done than surgery.

Bottom Line:All right, let’s talk about it. If somebody starts to get a bunion and is starting to get some—or even when they start to get a bunion, before they’ve got pain—what’s the type of treatment they should get?
Dr. Youner:First, see your podiatrist. Let the podiatrist evaluate the bunion. See if the bunion isn’t just an inflammation from a pair of shoes. You may have swelling there that is just from a poor pair of shoes you were wearing. If you can just get an injection to shrink up some swelling in some soft tissue, that’s fine. If it’s something that will require surgery down the road, that’s to be evaluated. But first, change your shoes.
Bottom Line:And it’s interesting; actually, in this case, treatment really is primarily a lifestyle change.
Dr. Youner:Yeah.
Bottom Line:No medicine, no drugs, just a lifestyle change.
Dr. Youner:Change your shoes.
Bottom Line:And how about prevention? I’m guessing it’s going to be watch your shoes again.
Dr. Youner:Watch your shoes. But if your mother has bunions and your grandmother has bunions, chances are you’ll have bunions. So first off, again, make sure your shoes fit. Do not wear shoes that are too tight…do not wear shoes that are too pointed. If you need to dress a certain way, make sure you have arch supports in those good shoes. Invest in your shoes. Don’t buy cheap shoes. If the shoes are not structured enough, go to the next pair.
Bottom Line:So tell me about the rules about a shoe. You say that they need to be a specific type of shoe.
Dr. Youner:Shoes need to have three factors to make it a good shoe—the heel counter should be firm so the foot is controlled…the shoe should not twist…and the shoe should only bend a little bit at the forefoot.
Bottom Line:Perfect. All right, thank you, Dr. Youner. The bottom line on bunions? This is a self-inflicted wound. It might run in your family…you might have a genetic weakness toward it, but basically, the shoes we’re wearing, ladies—we’re giving ourselves bunions.