Young people also weigh surgery to relieve ugly, painful bunions

Grandma isn't the only one with bunions.

Just 26 years old, Kacey Barker, of Haverhill, Mass., found herself with a painful joint jutting out from the base of her left big toe.

"Mine got progressively worse over the years," she says. "With all the sports and wear and tear…anything and everything was bothering it."

Barker a couple of years ago had to stop her athletic activities, including running, field hockey and softball. The pain became unbearable after a marathon-length charity walk in the fall, and she finally decided to have surgery to correct the toe's misaligned bone.

Six weeks later,  Barker, who manages funding for research grants, is still wearing a surgical boot to walk and is looking at another six weeks to fully recover. Her longer-term goal: rocking the dance floor pain-free at her wedding in September.

"A lot of my friends thought bunions are for women who are old or who wear high-heeled shoes for decades," says Barker, who says she tends toward supportive, sensible shoes.

An estimated 23 percent of adult Americans suffer from bunions, including more than two-thirds of people over the age of 65, according to a review of studies published in 2010 in the Journal of Foot and Ankle Research.

More than half of women get bunions, and women are nine times as likely as men to have the problem, according to the American Academy of Orthopaedic Surgeons. Some doctors say the growing popularity of high heels and pointy-toed shoes, including among very young women, has helped increase the incidence of bunions.

Although genetics plays a role in determining who develops one, motion and pressure, often caused by ill-fitting shoes, can trigger a bunion to form.

"There's a misconception that shoes cause the bunion. Shoes aggravate it and make it symptomatic," says Michael Trepal, a professor of surgery at the New York College of Podiatric Medicine. Usually, "it starts to occur in the early phases of young adulthood, and as time goes on, it progresses," he says.

Doctors typically recommend nonsurgical remedies as a first recourse. This can include a different kind of padding in shoes, orthotic insoles and ensuring that you're wearing a shoe that is wide enough and not too high, says Gary Pichney, a surgical podiatrist at the Institute for Foot & Ankle Reconstruction at Mercy Medical Center in Baltimore. While such approaches can reduce discomfort and may prevent a bunion from getting worse, they don't correct the condition. Pichney says about half of his patients end up opting to do surgery.

So what exactly is a bunion? It isn't an overgrowth of a bone, as many people think. Trepal explains that the foot contains five metatarsal bones, one behind each of the toes. In a healthy foot those bones are roughly parallel. A bunion is formed when the big-toe joint, or the metatarsophalangeal, becomes misaligned, causing an enlargement of the bone or tissue around it that appears as a bump.

The big toe often drifts toward the second toe and can affect the position of the other toes. The severity of the big toe's misalignment is what surgeons rely on to decide on the type of surgical approach to take.

There are many different types of surgeries to correct bunions, depending on the nature and severity of the problem. The most frequent procedure to correct the angular deformity is an osteotomy, or a bone cut at either the front, middle or back portion of the first metatarsal bone. The more severe the bunion the farther from the joint the cut is made.

Barker, after years of living with bunion pain, went to see James Ioli, chief of podiatry at Boston's Brigham and Women's Hospital, who last month performed a common type of osteotomy on her left foot called a chevron. This procedure involves cutting the front portion of the first metatarsal in a V-shape, moving the bone and holding the sections together with a fixation device, such as screws.

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