People walk into my office on a weekly, if not almost daily basis, crippling with pain from their bunions. Many patients report that it is the worst pain they have ever experienced in their lives. Often the biggest problem is the difficulty in getting shoes that don't press on the bunion directly and increase the pain. Those people who used to take pleasure in walking find that the bunion pain has made walking a chore and something they try to avoid where possible. Obviously this is bad news, not just for your feet, but for your over-all health too.
So what is a bunion? A bunion is a deformity of the great toe. The metatarsal of the big toe "buckles" as a result of too much force being applied to it. This makes that bone point away from the rest of the foot. As a result, the big toe is pushed against the footwear and is driven back toward the lesser toes, sometimes over or underlying them. There is good evidence to suggest thet bunions are hereditary, especially through the female line but there is also no doubt that lifestyle choices such as footwear and exercise play a big part in determining how much the bunion impacts your life.
Don't expect that size or shape of your bunion to change as a result of manipulation. Only surgery will offer any improvement in the way the joint looks. Although, you may think of manipulation as changing the position of a joint, the effects are more neurological than anatomical. Even after several treatments you will not see any noticable change in the appearance of the joint but it should feel much more comfortable. Some people report that the joint is more mobile but the main goal of manipulation is to decrease the pain you experience in the joint. Manipulation is not a cure and will not stop the joint deviating further in the future but, in my experience, it will usually offer you some good long-term pain relief.
An insole will not alter the size or shape of your bunion but in many cases it will help to redistruvbute pressure to different areas of the foot, helping to make the bunion more comfortable. Sometimes insoles can be difficult to tolerate as they take up room in footwear that is already pinching and uncomfortable. Because of these fitting issues, insoles are often best combined with a change in footwear style. Look on it as an excuse to buy new shoes!
Modifing your footwear can often be the most helpful thing you can do. Unfortunately, it is often the most difficult thing to convince most patients to do. It's okay to wear a nice pair of dress shoes when you are going out to a special occasion but these act like a straight-jacket to your foot, preventing any natural movement and increasing the pressure on your already painful joints. By wearing a flatter shoe most days, you will greatly reduce the pressure being pushed onto the ball of the foot. Even better if you can manage a lacing shoe which will allow you to keep a snug fit around the foot while affording extra space to the enlarged joint of the big toe. You're not convinced are you? If I could convince you to try a running shoe you would never look back. Without question, they are the most comfortable shoe you will find for your bunion. They will give contoured support to the foot with plenty of shock absorption and a good lacing system to ensure a good fit. They are light-weight and incredibly comfortable. Go on, try a pair.
Surgery should be the last option you consider. Its effects are permanent and irreversible and results are mixed, with many people still experiencind discomfort after their surgery. Having said that, in some circumstances it is the best option. Your podiatrist will discuss this at length with you and will be happy to recommend a surgeon for you, should you wish to pursue this treatment option.