Bunions in Runners: Prevention and Treatment

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What are Bunions?

Contrary to what some runners believe, a bunion is not an injury, deformity, or indication of a stress fracture. In actuality, a bunion is a structural issue that occurs when the big toe joint becomes subluxed, drifting towards the smaller toes. The displaced, widening bone (metatarsal) then becomes prominent on the inside of the foot, and the enlarged protruding area is known as a bunion. These bony, knobby protrusions can occur at the base of your big or pinky toe.

A bunion on the side of the big toe is known as valgus malformation. This bump at the site of displacement can become red and aggravated if there is too much stress on the metatarsophalangeal joint (MTP) over a long period of time, which forces the first metatarsal to turn outward and the big toe to point inward.

The bump can also become painful if it is in a constant state of rubbing against your shoe.  A bunion on the pinkie toe side of the foot is known as a bunionette or a tailor’s bunion. This bump occurs when the pinkie toe has drifted toward the fourth toe from abnormal foot structure or dysfunction. 

Often hereditary, bunions are actually a common condition. Many people who have bunions never experience any pain. For those that do, pain is often the result of inflammation in the toe joint and the surrounding area. Sometimes an inflamed pocket of fluid called bursitis can occur over the bump.

Pain from bunions can range from mild discomfort to a debilitating condition. Those with extreme bunion pain find daily activities like walking and wearing shoes difficult.

Photo from 4BetterFeet Podiatry
Are You at Risk for Bunions?

According to the American Podiatric Medical Association, those with arthritis, flat feet, inflammatory joint disease, or low arches, or more likely to develop bunions. You may also be at risk for bunions if you have a job where it is necessary that you are on your feet the majority of the day.

30 percent of the population have bunions. Bunions are more common in women than in men, and the chance of developing bunions increases with age. Anyone who has suffered foot injury involving a broken toe can be more prone to bunions as well. Some individuals have this abnormal bone structure from birth. You can also inherit bunions if this condition runs in your family.

There are certainly specific factors that can increase your risk of developing bunions, including wearing ill-fitting shoes during the day, and when you run!

When your shoes are too narrow, the side of the shoe will continually rub against the side of your foot and create an environment that triggers the development of bunions.

High heel shoes promote bunions since they shift pressure towards the front of the foot, bringing an added degree of pressure on the big toe joint. To prevent bunions, skip the tight, pointy high-heeled shoes, no matter how cute they are, and choose comfortable, wide-toed shoes instead.

If You Have Bunions, Can You Keep Running?

If you have bunions, they will not go away. The good news is that you can prevent them from developing further. With a few precautions, you can even keep running if you are diagnosed with bunions! 

Experts do advice runners to be aware that a bunion could lead to other more serious problems for runners. Since you engage your forefoot every time your foot touches the ground or lifts up when running, this can generate a lot of stress on your forefoot. This force in combination with an existing bunion can cause serious inward rolling of your foot when you walk or run, referred to as overpronation.

Pronation itself is simply the natural side-to-side movement of the foot when you walk or run. It is normal for your foot to roll inward slightly with each step. But in the case of overpronation, the ankle rolls too far inward and downward with each step. It will continue to roll even when the toes should begin pushing off. The big toe and second toe then make all of the effort to push off as a result, and the foot only twists more with every step. 

Overpronation can cause instability in the foot, as well as strain on the big toe and second toe. This excessive rotation of the foot causes too much rotation of the tibia in the lower leg, leading to increased cases of knee pain and medial tibial stress syndrome (shin splints).

Such stress on the foot’s tendons and ligaments from overpronation can also cause a greater incidence of heel pain and other injuries. Overpronation has a higher occurrence in individuals with flat feet, but this does not imply that everyone who has flat feet will also overpronate.

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In addition to overpronation, studies show that bunions can result in other foot problems. As you run, you may subconsciously shift your weight off the big toe that is in pain, which can lead to discomfort in the ball of your foot. 

If the pain is unbearable, then you should stop running and consult a doctor, a podiatrist, or a physical therapist. They can help you determine the source of the aggravation and prescribe treatments.

Once a medical professional does give you the green light to resume running, don’t return to running in the shoes that aggravated your bunion in the first place. And by all means, do not wear high heels, and risk tipping your weight forward and pushing your recovering toe into the front of the shoe. 

For work and walking around town, select comfortable shoes that have a heel of two inches or less and offer your forefoot and toes the room they need. For running, invest in a pair of shoes that have a wider toe box. Choose a pair that are considered zero drop shoes.

And after you can comfortably and painlessly run in those, then transition to a minimalist shoe that is designed to promote natural movement of the foot. Altra, Topo, and Vivobarefoot are a few brands that are popular among minimalist runners.

How Can You Relieve Bunion Pain? 

To give your toes and forefoot more space and take the pressure off that bunion, it’s a great idea to experiment with various lacing techniques.

For those with a bunion and a wide forefoot, try this lacing technique to give your foot plenty of space, allowing your toes to splay while running:

  • Start at the bottom of the eye row and lace up the sides of the shoe. 
  • Once you get to the midfoot or middle of the shoe, start the cross-lacing technique and continue it until you reach the top of the shoe. 
  • Tie your shoe at the top as you normally would.

For those with a bunion and a narrow foot, simply lace your shoe as you normally would, but skip the first hole on the inside of your shoe where your bunion is located.

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You can also relieve any pain related to the bunion by applying an ice pack to your bunion or soaking your feet in a warm Epsom salt bath. At-home E-stim devices promote muscle contraction, which is one of the most effective ways to decrease any inflammation or swelling.

Acetaminophen and ibuprofen can be taken, but use these medications sparingly, as they can be detrimental to runners over time. For an all-natural anti-inflammatory treatment, try incorporating cayenne into your meals. Cayenne contains capsaicin, an active plant compound that has pain-relieving properties that can minimize the intensity of pain signals sent throughout your body.

Moleskin or gel-filled pads can also be used to protect the bunion. Consider using toe spacers between the first and second toes, and sleeping with a night splint to hold the toe straight, stretch the soft tissue, and calm discomfort so you can sleep. Getting a foot massage from a sports medicine professional may also provide relief to the soft tissue in your foot. 

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To relieve existing pain from bunions and prevent issues down the road, work on strengthening your arches. These exercises will limit further bunion development: 

Heel Stretches

  • Stand in front of a chair, wall, or railing that is at the shoulder or eye level. Rest your hands on the support or wall. 
  • With one leg in front of you and the other leg extended behind you, press both of your heels firmly into the floor.
  • Bend your front leg as you push yourself into the support or wall while keeping your spine straight.
  • You should experience a stretch in your Achilles tendon and your back leg.
  • Hold this position for 30 seconds, then repeat four times on each side. 

Arch Lifts 

  • To work the muscles that help to lift and supinate your arches, stand upright with your feet directly beneath your hips.
  • Roll your weight to the outer edges of your feet while lifting your arches up as far as you possibly can. It’s important that you keep your toes in contact with the floor throughout this entire movement.
  • Then lower your feet back down, and perform two to three sets of 10 to 15 repetitions.

These exercises and treatments are not a permanent correction to your foot’s structural issue, but they can reduce pain and stave off surgery.

If You Have Bunions, Do You Need Surgery?

Bunions that are large enough to cause pain that impacts the activities of your daily life, such as walking and working, may require more extensive treatments. Steroid injections into the joint or even cortisone injections can be a short-term solution to bunion pain. Surgery is a last resort for those that don’t experience relief from any of the above treatments and procedures. 

Proper modern surgery involves realigning the joint by shifting the bone back into the foot. Podiatrists report that this solution is a permanent resolution to the condition, and some individuals return to running as soon as five weeks after surgery. Just don’t return to wearing the same shoes that aggravated the condition in the first place, or your bunion surgery will be in vain! 

If you do not take preventative measures, including running in proper-fitting shoes and strengthening your arches, it is possible for your bunion to return, even after a surgical procedure.

By addressing any overpronation, reducing inflammation, and focusing on proper form from head to toe, you can not only minimize discomfort from bunions but also move more functionally in running and in life. 

Sources

  1. American Podiatric Medical Association, Patients & The Public - Bunions, Medical Blog