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Q: I am 75 years old and have had a bunion on both of my little toes for many years. I also don't have good circulation to my feet. The other night, one of my bunions itched so much that I ended up scratching it off. It bled a little but now it seems fine.

The one I scratched off doesn't hurt as much when I put on shoes. What if I did that to the other one? What are bunions anyway?

-- M.O., Kilmarnock, Va.
A: A bunion results from the growth of tissue, including excess bone, around the joint of any toe. However, bunions almost always occur at the base of the big toe. Less frequently they form on the little toe.

Bunions of the big toe are caused by the end of that toe being forced inward by wearing tight-fitting shoes. This pushes the toe joint outward. This, in turn, causes trauma to that joint, resulting in the formation of a bunion.

As you would expect, because of shoe styles women are much more likely to develop bunions. Also, older people are more likely to develop bunions because they are more likely to have arthritis in a joint. The arthritis leads to increased swelling and changing the angle of the toes, which in turn increases the risk of damage.

The shape of a person's foot will influence whether a bunion forms. And, since foot shape is hereditary, so is the risk of developing a bunion.

The first sign of a bunion is usually pain. It may be mild to begin with but can become severe. The pain is most noticeable when walking in tight-fitting or high-heeled shoes. The skin around the bunion may appear swollen and red.

Treatment is best started early, with the goal of preventing the bunion and other foot deformity from getting worse. Early treatment consists of wearing wide and low-heeled shoes, padding the bunion, and using non-steroidal anti-inflammatory drugs such as aspirin or naproxen.

In more severe cases, cortisone injections may be considered to relieve swelling and pain temporarily. But they don't prevent further deterioration and do have risks of their own. Orthotic shoe inserts can also help control abnormal foot movement and may reduce symptoms. Of course, if there is any underlying arthritis or other joint disease, it needs to be treated directly.

Calluses will develop on any skin where there is repeated rubbing or friction. I suspect that you pulled off the callus but the bunion remains. Since you have poor circulation to your feet, examine and watch what you have done very carefully to make sure an infection doesn't start there.

There are many different surgical procedures used to treat bunions. The approaches have differed based on whether the bunion problem was considered mild, moderate, severe or arthritic. As you would expect, the worse the bunion, the more complicated and the more risky the surgery will be.

A recent study showed that distal chevron osteotomy, the type of surgery commonly used for mild and moderate bunions, was just as effective in more severe cases. This surgery allows the person to put weight on the foot much sooner after surgery than when using more complex procedures.

As with any medical procedure, try to understand all the benefits, risks and costs before deciding. One of those risks is that bunions will return in some people.

Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at This column is not intended to take the place of consultation with a health-care provider.

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