QUESTION

In a matter of weeks, I developed a moderate-sized bunion. Why is it growing so fast?

ANSWER

That is unusual. A bunion ordinarily takes years to develop. But I do have an idea of what might be happening.

As you know, a bunion (the medical term is hallux valgus) is a deformity of the big toe joint. Bunions form when the first bone in the foot shifts outward and causes the big toe to turn inward and rotate toward the smaller toes. The base of the big toe juts out, creating a bony bump at the joint. Bunions can be very painful and make walking difficult.

A variety of factors can increase one’s risk of developing a bunion. Age is one of the main risks. An estimated one out of every three adults over age 65 have bunions of varying severity. Heredity also can play a role—a predisposition for the condition is often found in our genes.

People with flat feet and low arches and those who stand a lot or engage in a high-impact physical activity, such as tennis or ballet, also are more likely to develop bunions. Even though wearing too-tight shoes and/or high heels can contribute to a bunion, this is not considered an underlying cause. Not surprisingly, women are at greater risk than men.

The fast-growing nature of your bunion does suggest that something else may be going on. It could be linked to rheumatoid arthritis (RA). RA is an inflammatory autoimmune condition that occurs when the immune system mistakenly attacks its own joints, causing pain and swelling. People with RA often develop deformities in their hands and feet.

A rheumatologist can diagnose RA with an imaging test, such as an X-ray or MRI, and a blood test. The condition is typically treated with an over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID), such as naproxen (Aleve) or ibuprofen (Motrin), a corticosteroid or disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Rheumatrex), and/or newer targeted medications, including tofacitinib (Xeljanz).

Lifestyle changes, such as maintaining a healthy body weight and eating lots of anti-inflammatory foods, including purple grapes, blueberries and dark cherries, also can help reduce pain and sometimes allow RA sufferers to limit or even avoid medication. If your bunion is linked to RA, it’s possible that the RA treatments described above may slow down the bunion’s progression.

For the bunion itself, there are various treatment options. If it’s not continually painful, simply wearing wider, low-heeled shoes with orthotic inserts will improve foot alignment and provide support. OTC bunion pads may prevent irritation. Using an ice pack for 20 minutes at a time, when needed, and/or taking an NSAID will ease bunion pain after walking or other exercise.

However, if your bunion is large and/or very painful, surgery may be necessary. There are many different types of bunion surgery, which involve shaving the bony bump and/or moving the foot bone into its correct position. Your surgeon will recommend the procedure that is best for you. Surgery is the only way to correct a bunion deformity. To find a foot surgeon near you, consult the website of the American Orthopaedic Foot & Ankle Society.