Loose Women actress who blames her arthritis on bunions
More than 15 million of us have them and, as Terri Dwyer found, delaying surgery can have agonising effects
AT TIMES the pain was so bad that it kept actress and TV presenter Terri Dwyer awake at night. hers isn’t the kind of pain you might associate with night-time waking — backache, for instance, or a creaky hip — but bunions. At times even a sheet over her foot was an unbearable weight.
Despite the pain, Terri, best known for her role in hollyoaks and as a host on Loose Women, resisted a suggestion from her doctor, when she was in her 30s, to have the bunions surgically corrected.
‘I didn’t want to take the time off — being self- employed and also having a young family means that would have been really difficult,’ says Terri, 47. Yet she now wonders whether she should have done it differently — as not only have her bunions got worse, she has gone on to develop arthritis in two toe joints and in her midfoot as a result.
‘no one told me that the constant pressure on the other joints in my feet caused by the bunions would then cause excruciating pain and stiffness,’ says Terri. ‘And that arthritic pain now causes me way more problems than the bunions.’
Bunions are bony growths at the base of the big toes — around 15 million people in the UK are thought to have them. They occur when the metatarsal, the long bone that forms the joint with the big toe at the ball of the foot, deviates one way and the top of the next toe goes the other way, explains heath Taylor, a consultant orthopaedic surgeon at University hospitals Dorset NHS Foundation Trust.
‘In simple terms, the big toe moves towards the second toe,’ he says. ‘We think some sort of imbalance occurs in the muscles that move the big toe or the connecting tendons, and this allows the big toe to move out of line,’ says Mr Taylor.
The problem is more common in women — though heeled shoes won’t cause a bunion, they may exacerbate symptoms, ‘and pointy-toed shoes may speed up the process in someone who is prone to them’, adds Mr Taylor.
WHEN the joint forms more of a right angle, hammertoes (where toes bend abnormally in the middle joint) can develop, and the big toe can become arthritic, he adds. ‘In more severe cases, the big toe joint comes out of line, leading to unusual wear-and-tear of the joint and arthritis: this will mean the bunion may cause stiffness as well as pain.
‘Sometimes the angle becomes so severe the big toe is pushed under the second and third toes, which can cause a lot of pain and make it hard to find footwear. I’ve seen people who can only wear slippers,’ adds Mr Taylor.
It was just after Terri had had her second son, Kylan (now ten), when she was 36, that her foot problems worsened considerably. (her older son, Caiden, is 14.)
‘I just couldn’t do any highimpact exercise classes on days I was going to wear high heels for an event, as I’d be in agony. I then progressed to having to have inserts in all my shoes,’ she says.
‘Bunion surgery was mentioned to me in my 30s but I decided to just manage the situation.’ But she’s subsequently developed arthritis, which has had a greater impact on her than the bunions.
‘At my worst, I would get out of bed in the middle of the night and shuffle around like an old woman,’ says Terri.
So, should someone with a bunion opt for early surgical intervention to prevent the possibility of developing complications?
‘Choosing when to do surgery is a balancing act between different factors, such as someone’s age, as doing it too early can mean they recur — although I have operated on a girl of 11,’ says Mr Taylor.
‘ You also have to take into account someone’s pain, and this can vary: a mild-looking bunion can cause a lot of pain and vice versa. And we must consider if there are complications in the other toes, and weigh that all against the risks of surgery, which include infection and pain and swelling that can last for months.’
The most common surgery involves shaving off some of the bone and re-aligning the joint.
Some studies show early surgery means more of the joint can be preserved, so patients need fewer pins and less bone cut off the bunion, says Dr Jill halstead-Rastrick, an academic podiatrist and a spokesperson for the charity Versus Arthritis.
‘The important thing is to monitor the progression of the toes and the arthritis pain with your specialist,’ she says. ‘If the angle of the bunion is getting worse, and you are in pain, then consider an earlier surgical opinion.’
But Dr halstead-Rastrick says while there is a strong link between bunions and arthritis in other foot joints, ‘we can’t say by delaying bunion surgery, it will conclusively lead to problems in other joints.
‘There is often a strong hereditary pattern in having a bunion in both feet and arthritis in other parts of the feet,’ she says.
In fact, Dr halstead-Rastrick says that bunion surgery, rather than preventing arthritis in the toes or the rest of the foot, can have the opposite effect.
‘For the unlucky few, bunion surgery can have a knock-on effect of destabilising the joints next to it,’ she says. ‘This can lead to pain — and possibly increase the likelihood of arthritis.
‘In these circumstances, some patients say they regret having the surgery as a result.’
It is difficult to predict who will and will not encounter such complications. however, research has found that a patient’s satisfaction with their operation is partly determined by what the surgeon says about it subsequently.
‘The influence of the surgeon, and the language they use to talk about how it went afterwards seems to have an impact,’ says Dr halstead-Rastrick.
Surgery is the last resort. Often bunions are managed in the short term with painkillers and specially designed footwear or insoles. Sometimes injections of steroids or hyaluronic acid, which helps lubricate the joint, may be given to ease pain and swelling.
‘In the UK, one in four people have a bunion, but only 5 per cent of those will have surgery to correct it,’ says Dr halstead-Rastrick.
Terri is now facing not just surgery to correct her bunions, but also surgery to fuse her arthritic toe joints to stabilise them and reduce the pain.
Two years ago, during the making of a film she was producing called Break, the arthritis pain became so bad that Terri needed a steroid injection into the toe joints of her right foot to reduce inflammation.
‘Things just got too much to bear,’ she says. ‘I have had four to six injections over the past two years in both feet. After the injection, I have to take strong painkillers for 48 hours to cope with the throbbing pain in my feet, but I am back to normal in about ten days.
‘however, my surgeon has told me I’m only allowed so many of these before the skin thins too much. If that happens, there would be nothing else they could do for me because I won’t be able to have the operation to fuse the joints — so my surgeon has told me that an operation is now becoming pretty close,’ she says.
Terri is hoping to somehow manage to last another two or three years, until her eldest son can drive, before she has surgery.
‘At the moment, my children need me,’ she says. ‘Plus, I don’t want to take another career break. I’ll try anything to help stay on my feet as long as I can.
‘ I’m sure I haven’t helped myself in the past by wearing high heels, but I’m also fully aware it’s probably the way I’m made.’ (Terri believes her mother also had bunions.)
‘ The irony of it is that my bunions now aren’t that painful compared to the joints that have deteriorated as a result. If I had my time again, and known what might happen with my feet in my 20s, I would have had surgery before I had children.’
BREAK is out on DVD, visit breakfilms.co.uk