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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!
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
Thanks for all the advice. I was looking around at wal-mart the other day and saw this gel type insert that you put between your big toe and the second toe to keep the big toe pulled away from the second toe and I also saw a device that you wear at night while you sleep. Has anyone got any opinions or experience with things like that?
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.
Thanks, that is very good advice. Even when I was not a runner and just a really hard worker I always thought I needed to go see about my bunions. Now that I am running sounds like I really should not make it an option. I love running. It has caused me to quit smoking and feel better than I did even in high school. If I could not run I am afraid I would get sucked back into smoking, so for me running is life or death, or atleast a good quality of life. I am going to try some cross training this week with swimming and biking. I never have used either of those for exercise but I guess I need to do it just incase injury puts me out of running permanently at some point in my life, and I want to do active things on my off days from running. The worst thing about it is that I never wore high heels or any of the things 'they' say causes bunions to form. I can only guess that my gait has always been wrong, not sure. I hope that I have not waited too long either. I run and only have tenderness around my bunions but also have always had tenderness around them when I am on my feet too long.
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!
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.