Instep Dance Magazine Articles
Reprints of monthly column as first appearing in Instep Dance Magazine (no longer in print).
April 2003Error processing SSI file
Bunions and Hallux Valgus
Presented by Rick Allen, DC
"Better health leads to better dancing."
One of my patients who dances recently came for care that included treatment of her feet for bunions and hallux valgus. A bunion is a painful swelling of the soft tissue and bone enlargement on the inner side of the ball of the great toe. Initially, there is partial dislocation outward of the great toe (hallux valgus), which makes the head of the metatarsal bone prominent (compare the left and right figures below, which are drawn from "Conquering Athletic Injuries," the reference for this article).
The most common cause of bunions and hallux valgus is a combination of hereditary tendencies and biomechanical imbalances. Excessive pronation, commonly seen as flat-feet, places excessive stress on the inside of the big toe during the toe-off phase of the gait, forcing it in a lateral direction, toward the smaller toes. Wearing high-heeled shoes with pointed toes create a structural imbalance that may lead to this painful condition. Metabolic conditions such as arthritis, gouty arthritis, and rheumatoid arthritis may be predisposing factors to the deformity. Injuries may also lead to bunion manifestation.
As the bunion develops, the head of the metatarsal bone enlarges from shoe irritation. The bunion sufferer begins to experience pain and discomfort in the area of the ball of the great toe, especially after exercise. A bursa (sac of fluid) forms over the inner or top aspect of the bony prominence. The pain then becomes more intense, owing to an acute attack of inflammation in the bursa and possibly also in the neighboring joint. Very often, the great toe is angled toward the smaller toes and may overlap or underlap the second toe. Therefore, the mechanical imbalances and the development of the bunion can create deformities of all the lesser toes.
The first choice in the treatment of bunion deformities is a conservative, mechanical approach. The simplest home treatment is to place a toe separator between the first and second toes. This can be made from a piece of 1/4-inch thick foam or polyurethane foam. Hold the separator in place with a small piece of tape around the great toe.
Another form of home treatment is to create a bunion shield by cutting a hole in a 1/8- or 1/4-inch felt pad and placing it over the enlarged bump on the metatarsal head. You may then hold the toe in a straight position by using 3-by-3-inch adhesive tape. Hold the toe in this position by anchoring the tape around the base of the great toe, then extending it behind and over the bump (over the pad). Follow with one or two pieces of tape transversely to lock it in place.
My patient found a similar device on the Internet at www.footsmart.com. (See the photos of her feet - Can you guess who she is?) The Night Time Bunion Regulator costs $15.95 plus shipping.
Home treatment should also involve checking shoes for fit and style. Shoes that are too short or narrow or have a narrow or pointed toe box aggravate the bunion deformity. Without changing the underlying functional causes of the deformity, even the most sophisticated mechanical support or surgical procedure will not solve the problem long-term.
If home therapy fails, seek the advice of a sports chiropractor or podiatrist, who can evaluate the problem from a radiological standpoint as well as consider the biomechanical, functional, and structural deviations. Custom orthotics may be required. X-ray evaluation is essential in determining the joint status, viewing changes in the joint space, and assessing the possibility of cartilaginous changes that may lead to arthritic changes.
If the bunion deformity is of a simple nature, a simple bunionectomy (removal of the bump) can be performed to reduce the enlarged bone. However, when the great toe is also deviated into a valgus position, this deformity must be reduced by a surgical osteotomy (fracturing of bone) of the great toe to place it in proper anatomical position relative to the metatarsal head.
While you can't change your genetic predisposition for this problem, you can lessen the likelihood of it occurring or worsening by wearing sensible shoes. You may need orthotics to lift the front arch under the metatarsals. In addition, for the female dancer, you may also have to lower the heel and widen the toe of the shoe.
"Conquering Athletic Injuries" from the American Running and Fitness Association, of which Dr. Allen is a member.
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Error processing SSI file