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2599 Views 8 Replies Latest reply: Sep 28, 2011 12:33 PM by rupertli
goals123 Amateur 9 posts since
Feb 23, 2011
Currently Being Moderated

May 27, 2011 1:34 AM

Bunion advice please?

Hello runners! I started running in February. I have not been very active in about ten years. I have ran a couple of 5ks and have a 10k planned for June and a half marathon planned for September. So needless to say I am increasing my milage. No injuries as of yet accept a little achilles tendon pain, which is healing up nicely thanks to my LRS and not over doing it. I have always had bunions on both feet since as far back as I can remember. Right now when I run I only have a little tenderness around my bunions. They are the huge ones by the big toe that make your toe point in the wrong direction. Hoping to get some advice on the progression of bunion pain and running more miles. I am very concrned that later down the road I will start to have problems with these curses on my feet. I was also wondering if anyone has experience with the inserts and things made for bunions that are supposed to help the problem from getting worse without having to have surgery-did it work, did it cause more pain, etc.? Thank you for any advice!

  • run lou run Rookie 4 posts since
    Feb 5, 2008
    Currently Being Moderated
    1. May 27, 2011 3:01 AM (in response to goals123)
    Re: Bunion advice please?
    I developed a bunion on my left foot after 6 years of competitive running. The best thing I did was to change to a shoe with a wider toe box that does not have any kind of stitching that hits your bunion. Get a custom fit at a good running store. Beware though of how you lace your new shoes. I developed a bad tendonitis on the top of my foot because I was tightening them to much to make up for the wider toe box. I also use the silicon pads that wrap around your toe and pad the bunion while I run. I loved them! I've found that being preventative is the only way to deal with a bunion because there is really no cure or "post" run care for it. I've been told to avoid surgery unless it's inhibiting your normal day to day life. Hope this helps!
  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    2. May 27, 2011 4:30 AM (in response to run lou run)
    Re: Bunion advice please?

    The medical literature provides conflicting advice/evidence regarding shoe whether shoe inserts (custom orthotics) are beneficial or harmful for the management of bunions (hallux vaglus deformity).  There is some literature that custom orthotic inserts speeds up the progression of the deformity.  In my experience there is a strong relationship between the parents that you choose and whether you have bunions (hallux valgus) or not.  Therefore I expect in the future the most effective therapy will be "gene therapy".  I agree with run lo run that best practice is to manage the problem with optimal shoe fit.  To provide enough room in the toe box of the shoe, consider skipping one or two of the shoe lace eylets.  I have recommended to some of my patients that they take a carpet knife to the shoe upper and slice a openning to provide adequate space, in effect making a running sandal.

    Damien Howell PT, DPT, OCS - www.damienhowellpt.com

  • run lou run Rookie 4 posts since
    Feb 5, 2008
    Currently Being Moderated
    4. May 28, 2011 5:13 AM (in response to goals123)
    Re: Bunion advice please?
    OOOOoooo I like the slicing the shoe idea. I've tried the insert that goes between your toes and it tend to slip out at night unless you wear socks to keep it in place. I've used home stuff like a soft, fabric wrapped around the toe to keep it out or one of those soft make up sponge squares. Best one is the pad that goes on your bunion for walking a lot or running.
  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    5. Oct 1, 2011 9:47 AM (in response to goals123)
    Re: Bunion advice please?

    One of the common threads I observe in the Med Tent is the burning    desire to run, and continue to run, through any kind of malady or    setback. Seems crazy at first, until I realize I've often done the same.    I think it's wonderful that the joy of running so easily overwhelms   the  fear of pain. It is a great lesson for life, aside from the fact   that  running with a painful condition is often as dangerous, as it is a    testimony to the glory of sport.

     

    Running from symptoms    is another thing I marvel at. A bunion, though clearly an adaptation  to   stress, is often viewed as a deformity and treated as such. While  you   may have had yours as long as you can remember, the time before  you can   remember is most critical. If you can find some early pictures  from  your  youth, see if you can detect any bunions. Probably not, but  the  reason for  the later adaptation has probably been with you from  the  beginning.

     

    The  business of genetics has changed a  lot in  recent years. While certain  characteristics such as eye color  appear to  be hard-coded and impossible  to change within your lifetime,  most of  your genes allow for adaptation  or "expression" to take  place. That is,  they are "switched on" by  environmental stresses. Many  of these  adaptive traits can then be passed  on to succeeding  generations, and  the tendency to develop a bunion is  most likely one  of these traits.  That does not mean that it is  unavoidable.

     

    I'm  willing to  bet that, had you lived  your entire life in zero gravity,  you would  have no bunions at all. Some  stress on your foot throughout  your life  is no doubt responsible for  this gradual change, but as is  so common in  physical medicine, we notice  and tend to the results  rather than the  cause, citing genetic history  as a way to explain it,  so we can  concentrate on dealing with the  aftermath, in keeping with a  kind of  "family tradition." I look at it  this way: There are probably  some of  us who develop bigger goose eggs  than others when wacked with  a hammer,  but I am less concerned with the  minutia of pathology, than  I am with  the hammer!

     

    I used  to run with a former  collegiate runner  who had a bunion on just one of  her feet, not both.  While she planned  to have it surgically removed,  could the genesis of  her condition have  had something to do with running  endless circles  around a track?  Maybe.. or maybe one leg was shorter  than the other.  There are many  possible reasons, with one obvious and  often painful  result, yet many  remedies are offered, some of which  address probable  causes, and most  of which treat the symptoms. As with  most injuries,  an ounce of  prevention is worth a pound of cure. Your  bunions may  never disappear  without surgery, but that is no reason to ignore a  lifetime of causative  factors that are likely still there.

     

    In  my view, the feet  of the average bunion sufferer  are inherently  unstable, for standing,  walking, or running. This  instability is best  described by placing the  fingers of your hand on a  table, and lifting  the wrist upward to mimic  how your foot pushes of the  ground as you  ambulate. you will note that  your middle finger supports  more of the  force of this forward thrust as  you move forward. In the  case of the  hand, the thumb is almost useless  during this action because  it is too  short to maintain contact. The  index finger is only in play  during  the beginning of the movement  because it is also too short.

     

    This   dynamic changes when  you rotate the wrist in pseudo-pronation to  spread  the load between the  index and middle finger, and a similar  action is  performed by the feet  of most bunion victims. Watch a child  crawling on  all fours and you  will see a similar move to spread the  load toward the  larger thumb. A  bunion is an obvious adaptation to  reinforce this same  action, in a  foot with metatarsal lengths that are  a bit more hand-like,  than would  be the case in a foot with more  mechanically efficient  metatarsal  length. One thing you will note when  looking at x-rays of  bunions, is  that  the length of the first  metatarsal bone in most  bunion-deformed  feet is  less than the length  of the neighboring  metatarsal, regardless  of toe  length.

     

    While  there is a  lot you can do to  accommodate and/or ameliorate the  effects of this  adaptation now, it is  way too late to prevent a  lifetime of cause.  Metatarsal length is only  one factor that is  evident before you learn to  walk, and there are  other subtle  variations in hip, knee, ankle, or  bone structure, that  will deliver  the same result, regardless of bone length. Each has its  own strategy  to regain mechanical  advantage while minimizing  restriction of natural  movement. In the case  of metatarsal length,  there are mild  quasi-prosthetic approaches to  footwear that can benefit  the next  generation to inherit this  arrangement, but reversal of an  advanced  condition, without surgery, is  out of the picture as far as I  know.

     

    Bunions  can advance to an arthritic condition that results in painful  loss of  joint cartilage. I am hoping you have found us before this  occurs.  While there are many inconvenient or unsightly adaptations to  the human  form, not all will result in the pathology of chronic pain.  Your feet,  however,  along with their bunions, are far too important to  risk on  half-baked  solutions with a predictable half-life.

     

    You   need to have the entire  structure of your gait analyzed by a physical   therapist with solid  sports experience, and a carefully drawn prognosis   rendered before you  commit yourself to an uncertain future. My advice   is to delay any plans  of a half-marathon until you have taken these   steps. I too, love to run.  I have short 1st metatarsals, and took   corrective action before too  many years of too many miles resulted in   any major deformity. While you  are likely past that point, there are,   literally, steps you can take to  brighten your running future. Please   get serious about it now, while you  still have choices to make.

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    7. May 31, 2011 2:25 PM (in response to goals123)
    Re: Bunion advice please?

    When you brought up the shoes it reminded me that bunions have even been observed in shoeless aboriginal peoples. It would be funny if these tribes were actually wearing shoes, but removing them for the cameras so they can get published in National Geographic, but i'm pretty sure they are developing them without. A few podiatrists have mentioned this apparent contradiction. In fact, I think it's the bunions that are running into the shoes after they begin to form, hence the irritation and popular belief.

     

    I don't want to discourage you from running at all, but I would be more comfortable knowing you had a lifetime of your chosen sport ahead of you, rather than a temporary respite from smoking. I am impressed by your motives and resolve, and hope there is a strategy out there that can keep you safely on the road for life. I'll continue to research the subject, as the medical community begins to take both bunions and fitness more seriously. Good luck with your cross training!

  • rupertli Rookie 2 posts since
    Jul 25, 2007
    Currently Being Moderated
    8. Sep 28, 2011 12:33 PM (in response to goals123)
    Bunion advice please?

    I'm training for my next half marathon and one thing that has helped me reduce the pain of my bunion (only on my right foot) is Bunion Bootie (www.bunionbootie.com).  I highly recommend it and have been telling every running friend i have about it!  I no longer have to search for that bunion "solution" - especially since I refuse surgery.  You don't feel it at first (which is good) but after wearing it a  few weeks non stop I do notice that besides providing the obvious barrier to friction and rubbing, it actually does seem to reduce my bunion (perhaps b/c it's not irritated?)  Either way, it is so comfortable that I actually WANT to wear it.

    I've tried everything else and my bunion has actually caused my right big toe to start poking out of my running shoes, it's crazy!

     

    I also switched my asics to a cushion shoe instead of stabilizer....that seemed to help my comfort level a bit.

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