A recent Framingham foot study revealed that approximately 25 percent of the population ages 18 to 65 have a bunion deformity and greater than 35 percent of the population over the age of 65 have one. As a painful and sometimes debilitating deformity, there is no wonder why athletes seek out consultation on how best to manage this painful condition.
What is a bunion? A bunion is clinically recognized as a bulging bump at the inside aspect of the big toe joint that can become red, sore and very painful. When looking at a bunion on an x-ray, doctors expect to see a divergence between the first and second metatarsals. There is also malalignment at the big toe joint with deviation laterally towards the lesser toes. Depending upon what stage and accompanying conditions surround the bunions some degree of arthritis may be present as well.
What causes a bunion? Tight narrow shoes (ladies who love heels know what I am talking about!), structural deformities, high levels of stress and strain to the big toe joint, certain foot types and certain medical conditions such as rheumatoid arthritis, gout and psoriatic arthritis are all causes and culprits of bunion formation.
Why do bunions concern athletes? The medical community’s findings indicate that a bunion deformity is a significant and disabling musculoskeletal condition that affects overall quality of life. Bunions are especially concerning to athletes for many reasons, the most important of which is pain. Pain emanating from the bunion may affect the athlete with certain shoe gear, as well as through the arc of motion at the joint. It is this pain that is often times a limiter in performance, as well as the cause of other aggravating injuries such as stress fractures, neuromas, hammertoes, ankle instability, as well as knee, hip and lower back pains. Pain and compensatory injuries will cause an athlete not to reach their full potential and suffer with injuries season after season. If you think you suffer from bunion deformity, a full consultation by a doctor is needed to discuss appropriate treatment options.
How do doctors evaluate the seriousness of a bunion? A doctor’s evaluation begins with understanding the etiology. Is this condition inherited (i.e. parents, grandparents, etc.)? Is poor shoe gear selection to blame for the narrowing of the forefoot and the precipitation of the bunion deformity? Does the athlete have a pronated foot type which is known to be a mechanical precursor along with contraction in the gastrosoleal complex? Answers to all of these questions, along with x-rays, help your doctor evaluate the underlying etiology, the severity of the bunion and the best course of action.
How are bunions treated? Many athletes suffering from bunion deformities will benefit from conservative care such as stretching and strengthening exercises, shoe gear modification, custom orthotics, ice and compression (check out www.ice-sox.com for a superior means of ice and compression therapy) and nonsteroidal anti-inflammatories. However, other athletes may need surgical intervention to help realign the metatarsal and toe joint for improved mechanics, as well as protect the underlying joint cartilage from further arthritic degradation. While surgery can be scary, often times for patients with severe bunion deformities, surgery is the only treatment option available to alleviate pain and helps achieve better mechanics and a greater sense of balance, proprioception and range of motion, which substantially reduces the risk of developing the aggravating injuries discussed above. There is no one-cookie cutter procedure for bunion surgery and factors your doctor needs to take into consideration are age, activity level and overall expectation of the surgery. If you and your doctor determine surgery is the best course of action, make sure you discuss in depth with your doctor the expected recovery time and how long you will be off your feet. While surgery is a big next step, when undertaken for the right patient, you will achieve great results and keep your active lifestyle moving in the right direction.
Talk to your doctor and get to know your options regarding conservative and surgical intervention for bunion deformity. If surgery is discussed be sure to understand what procedure you are having and why that procedure is best for you. An educated patient is a good patient.
Dan Geller, DPM
Sports Podiatry/Foot and Ankle Specialist
This story first appeared on hitthegroundrunning.me.