AMAL AND THE BUNION BRIGADE
Mrs Clooney’s not the only star with tootsie trouble. So is there a cure for this bugbear?
THe sight of Amal Clooney’s gnarled f eet yesterday will have had many of us mere mortals flinching in sympathy. She may be a leading international lawyer, with the thinnest legs since Bambi, the thickest hair since Rapunzel and the hand in marriage of the hottest man in the world, but she does have an Achilles heel — two prominent, and painful-looking, bunions.
And she’s far from alone. For Mrs Clooney reluctantly joins a growing army of female celebrities afflicted by these deformities.
As fellow sufferers Victoria Beckham and Catherine Zeta- Jones would admit privately, bunions are no respecter of fame or fortune: a combination of genetics and the wrong type of shoes can, and do, floor women from every social circle.
So what are these unsightly podiatric protrusions — and how can you get rid of them? ALICE SMELLIE has the answers.
WHAT ARE BUNIONS?
JUST as no two human beings are the same, so each bunion differs hugely in severity and appearance.
‘Bunions occur when the foot rolls inwards, putting weight onto the metatarsal bone — the lower joint of the big toe,’ says consultant podiatrist emma Supple. ‘Over time, the bone becomes inflamed and the surrounding area swells with synovial fluid — the lubricating fluid which protects the bone — which, in turn, prevents the muscles and ligaments from holding the toe straight. In the worst case scenario, the joint can actually detach.’
WHO GETS THEM?
‘BUNIONS are not genetic, but foot type is,’ says consultant podiatrist Dr tariq Khan, of the Wilbraham Place practice in London’s Chelsea.
In a normal walk, the heel will hit the ground first, followed by the middle part of the foot and finally the toes. ‘But in nine out of ten cases, this doesn’t happen,’ says Dr Khan.
‘up until the age of six, everyone waddles like a flat-footed duck. then the heel bone rotates outwards and we develop arches in our feet. But nine out of ten of us end up with flatter feet than we ought to, and that means you’re more prone to developing bunions as your weight falls incorrectly every time you take a step.’
this may seems like a lot of flat feet wandering the streets, but not everybody is going to have bunions, points out Dr Khan. ‘Most children wear good fitting shoes and women tend to suffer only later in life. It usually takes years for bunions to develop to the point where they cause problems.’
HOW LIKELY AM I TO DEVELOP BUNIONS?
YOU can test whether you are likely to develop bunions by stepping out of the bath with wet feet. ‘If the resulting footprint has a crescent shape missing from the middle part of your foot, then congratulations!’ says Dr Khan. You have high arches, which means bunions are less likely.
‘If the resulting footprint looks like a pancake, you need to be careful with footwear,’ says Dr Khan. this means you have flatter feet and therefore a tendency to bunions.
WHY DO THEY BECOME A PROBLEM?
Feet become flatter as the years go by, and the type of shoes we wear hugely affects their health.
‘Narrow-fitting and high-heeled shoes put more pressure on the metatarsal joint,’ says Dr Khan.
Surprisingly, flat shoes such as ballet pumps and flip-flops, can be just as much of a problem: ‘ the foot splays out and the bunion will still form.’
It also doesn’t make a jot of difference if you’re wearing Jimmy Choo designer shoes or High Street ones from Primark.
‘Spend as much as you like,’ says Dr Khan. ‘If they are ill-fitting, you’ll get bunions.’
So what shoe to wear? ‘ think Strictly Come Dancing shoes,’ says emma Supple. ‘ A slight heel — about an inch-and-a-half, a strap or buckle and a wide, round toe.’ the small heel helps to hold the foot in the right position.
Style- savvy women should note that this season’s Mary Janes are the fashionable friend of the bunionprone foot.
ARE BUNIONS SEXIST?
‘MEN and women have the same tendency to develop bunions,’ says emma Supple.
‘Although male shoes tend to be built for comfort, so bunions are less likely to develop to the point where they cause problems.’ Neither do bunions discriminate against age. ‘A few years ago I worked with the BBC looking at the feet of young teenage girls,’ says Dr Khan.
‘Some had already started to have that deviation from wearing ballet pumps and will have problems in later life.’
If a shoe rubs or the joint aches, it’s an indication of a problem.
WHAT ARE THE STAGES OF BUNIONS?
‘SOME people suffer no pain at all and simply have the bumps without any symptoms,’ says Supple. Amal Clooney seems to be one of those, as she looks perfectly comfortable. Others are not so lucky, however, and go through various stages of discomfort. ‘First of all the synovial fluid becomes inflamed, and that’s why you get the initial red lump on the side of your foot,’ says Dr Khan.
‘Next the muscles and ligaments running up and down the big toe, which work to keep the toe straight, start to pull the joint away from the inside of the foot outwards.
‘As the joint becomes increasingly traumatised, and having lost the cushioning of the fluid layer, arthritis begins to form as bones rub against each other.’
the final stage, which is rare, is where the joint detaches altogether. ‘this is known as a windswept bunion,’ says emma Supple.
ANY TRUTH IN THE OLD WIVES’ TALES?
‘I KNOW that mustard poultices used to be recommended,’ says emma Supple. ‘But it’s not something we suggest now — although cold compresses may be useful to help reduce inflammation.’
In terms of the folklore adage that bunions throb in the event of an approaching storm, no clinical studies have so far been conducted into changes in air pressure and resulting foot pain.
SO WHAT CAN WE DO?
AS WELL as wearing more sensible shoes, there are practical steps to
ensure feet remain comfortable and bunions don’t become worse.
‘A podiatrist will examine the joint and get an idea of how low your arches may be,’ says Dr Khan. ‘They may suggest exercises, over-thecounter remedies such as gels, bunions pads, anti-inflammatory medication or splints to hold the toe in place.’
Special insoles, designed to make the foot move correctly, can be made and inserted into shoes.
WHAT ABOUT SURGERY?
This is a last resort and needs to be performed by either a podiatric or orthopaedic surgeon. There were 3,781 recorded hospital admissions in the UK for bunion surgery among men, and 29,258 admissions for women, in 2013. According to NHS statistics, surgery improves symptoms in 85 per cent of cases.
There are many different procedures available — more than 100 according to BUPA — none of which sound desperately appealing; shaving off the side of the toe to reduce the bump and/or pinning the toe back into place.
‘Your surgeon will tailor your procedure to you,’ says Emma Supple. ‘You can often have surgery under a local anaesthetic and be treated as a day patient.
A common correction of a bunion is a Scarfe Akin procedure, which involves repositioning the bone and inserting tiny screws into the new position. This means that you can walk almost immediately after surgery.’
Although the procedure may sound straightforward, you are looking at up to three months of not being able to drive.
‘it takes six weeks for bone to heal,’ she says. ‘You’ll spend two weeks in a surgical boot and the next four weeks pottering around in an oversized trainer — your foot is still swollen and bandaged. After three months you ought to be back in normal shoes.
‘That means whatever feels comfortable (and with your surgeon’s advice). if you’re able to wear stilettos again, then do. it’s unlikely that the bunions will come back — only very occasionally is this a complication.’
WILL EXERCISES BE OF ANY HELP?
ANYONE with the slightest indication of bunions should try the following exercises, recommended by Dr Khan. 1. SIT with your feet out in front of you with a rubber band held between your two big toes. Pull feet away from each other so toes are straight. Do for two minutes twice a day.
2. STAND on tissue paper and gather it up with your big toe. This exercises all the muscles in the foot and helps to redevelop the muscles in the arch of the foot.
3. STAND facing a wall. Rise onto your tip toes and hold for two minutes. This stretch works the deep muscle in the back of the leg which runs all the way from behind the knee to the ball of the foot, s and helps to keep the toe supple.