Bunions literally give millions of people a big pain in the foot, and physicians agree that there are a few alternatives for treatment.

One is wearing shoes which will ease the discomfort; the other is surgery."A bunion is essentially an enlarged big toe joint that can affect one or both feet," said Dr. Phillip Evanski, an orthopedic surgeon at New York University Medical Center. "Bunions rank among the leading foot problems, along with hammer toes, corns and callouses, and spurs."

Evanski said genetic factors appear to play a role - bunions often run in families - and that they seem to affect women in far greater numbers than men.

Bunions also affect older people to a greater extent than younger. He estimated that 5 percent of those over 65 will have a significant complaint about bunions, compared to 1 in 2,000 young people.

"Just wearing shoes helps to create a bunion problem," Evanski noted. "The incidence of the condition is far less in cultures where people do not wear shoes."

It is thought that bunion formation is accelerated when a person crams symptom-free feet into ill-fitting or high-heeled shoes. But Evanski noted that bunions may also be caused by other factors.

"It is in part a degenerative disease, in that the older we get, the more common the problem," he said. "Arthritis and some muscle disorders can also cause bunions."

Evanski said many people find relief by wearing shoes with wider widths in soft leather, or strap shoes where leather does not touch the protruding bone.

In severe cases, orthopedic shoes may be needed. They are made from a mold taken of the individual's foot.

"If neither option helps, the alternatives are living with the problem, or surgery," he said.

Surgery is often viewed as a treatment of last resort for bunions.

Available procedures range from a simple bunionectomy, in which the bump is removed and the ligament tightened, to a fairly complex osteotomy, in which the bone is cut and then realigned.

Depending on the specific surgery, full recovery can take from six to 12 weeks. The period of post-surgical disability depends on the amount of standing and walking one does; the less of these activities one can manage, the sooner full recovery is achieved.

Some 80 percent of bunion surgeries are successful, Evanski reported. Another 10 percent produce "fair" successes, and the remaining 10 percent yield unsatisfactory results.