Q: I'm developing a bunion on the outside of my big toe. Is this normal for a runner? Does this pose a problem? It doesn't hurt, but looks awful.
A:A bunion - medically known as hallux abductovalgus, or HAV - is growth and swelling around the bone, (normally on the outside of your big toe), which produces a "bump". The head of the first metatarsal bone (the bone connected to the base of your big toe), enlarges - due to pressure - which results in “movement" of the big toe towards the second toe, and loss of structural alignment. Extra weight is then placed on the ball of the big toe, which results in the bunion forming. Bunions are related both to genetics (the inherited structure of your foot), as well as to the excessive pressure created by pronation during running footstrike. (While poor fitting running shoes can help create a bunion problem, bunions have been known to occur even in individuals who run barefoot - due to the trauma of pronation on a poorly constructed foot). A bunion responds to increased pressure by growing larger in an attempt to handle disproportionate weight distribution.
Having a bunion is not necessarily a problem unless it becomes a continuing source of pain and discomfort while standing, walking, or running. I have found that approximately 20% of the distance runners I have worked with over the years develop small bunions on the outside of their big toes. For most, this has proven to be only an unsightly addition to their foot's appearance, and they have experienced no pain. I have had two athletes over the years whose bunions did grow to the point of great discomfort - negatively impacting their ability to run - and eventually requiring surgery. I have found this to be the exception, rather than the rule, when dealing with bunions.
Bunions are progressive, however, and do not dissipate with time.
Treatment for mild bunion deformities involves reducing pressure on the foot. Many runners find that switching to a running shoe which has a rounder and "deeper" toe box, made of softer and more pliable material, provides immediate relief. Pads and cushions can be used to relieve pressure between the bunion and shoe, as well as between the big and second toe. (Unfortunately, these pads often make for an uncomfortable and impractical "fit" inside of your running shoe). I have had athletes "punch" a very small hole through the outside of their running shoe to relieve pressure with good results. The use of orthotics can also help to eliminate excessive pronation in some cases - as can realignment of stride length through biomechanical analysis and the implementation of corrective running technique. Icing a bunion can also help discomfort by reducing the swelling surrounding the big toe. Flexibility exercises for the calf and foot, as well as strengthening exercises for the ankle and foot, are also recommended.
When conservative measures fail to provide relief, surgical correction is sometimes necessary. (*Although surgery is always considered a last resort). Again, I have rarely seen running bunions progress to this level of discomfort.
Normally, following a surgical procedure, a running program can be resumed within twelve weeks.
If you have any questions regarding your bunion, Marisa, I would suggest consulting a podiatrist or orthopedist. While in general, bunions rarely create serious problems in runners, it is good practice to get a qualified medical opinion on the condition of your feet whenever you have concerns.
