How can I avoid, delay or care for bunions?
Got bunions? This deformity is so common that some dancers, teachers and pointe fitters simply refer to the big toe joint as “the bunion joint,” whether or not the deformity is present in an individual foot.
But what are bunions and how do you get them? From your grand plié or your grandmother? Can you avoid getting them if they run in your family? Here, Dr. Lisa M. Schoene, a Chicago-based podiatrist and sports medicine specialist, helps RP provide straightforward information about bunion development, anatomy and treatment.
Bunion genetics You may have heard that bunions are an inherited condition. In fact, it’s a foot type that is inherited, making you predisposed to developing bunions. Dancers with a family history of bunions don’t always get them. Dancers without family history can get bunions, too.
Whether or not you inherited a tendency to get bunions, your dance training may make them worse or more painful, and it may make them develop sooner. Fortunately, though, you can avoid the primary factors in your training and footwear that contribute to bunion development.
What is a bunion? The word “bunion” actually refers to the bump that develops on the big toe joint. The bump is just one part of the condition known as hallux valgus. In hallux valgus, the tip of the big toe drifts toward the little toe. This makes an angle at the big toe joint, which should be basically straight. The joint becomes enlarged, inflamed and often painful. Tight shoes and heavy use of the feet tend to make the pain worse.
Rolling in The key to hallux valgus development is over-pronation (“rolling in”). The foot naturally rolls inward and outward when you walk, run, climb or jump. Over-pronation happens when the foot rolls toward the big toe too much, too often and at the wrong times. This makes the first ray (the bones leading to the big toe) unstable, and the big toe joint overly mobile.
Faulty technique People who inherit a tendency toward hallux valgus have feet that naturally tend to over-pronate. Unfortunately, many dancers without family histories get an “artificial bunion gene” in ballet class.
How? Forcing turnout, by pushing the toes outward, inevitably leads to rolling onto the big toe joint. This over-pronation affects the foot regardless of whether or not your mother, grandmother or aunt has bunions.
Although bunions may emerge during pointe training, pointe shoes aren’t always to blame. As you get older and train more intensively, any stresses to the body have more impact, including over-pronation. Even dancers who never go onto pointe may have premature bunions.
Shoe choices Nonetheless, pointe shoes can contribute to bunion development, for two reasons. First, dancers who over-pronate on flat often “wing” (roll toward the big toe) on pointe. Second, if your pointe shoes don’t fit properly, there is even more pressure and stress on the big toe joint.
If the toe box is too tapered or too narrow, the toes are squeezed together. The big toe is pressed and angled toward the other toes. Then, the weight of the body is absorbed at an angle, instead of vertically through the foot to the end of the toes. This mimics over-pronation and can cause the same problems, including bunions.
This can also happen with a toe box that is too square or too wide. It just happens in a different way. With too much room in the box, the toes can drift into any number of inappropriate positions. It is most likely that they will collapse so that the weight is pressed into the big toe joint.
To a lesser extent, street shoes or other dance shoes can stress the feet in similar ways. High heels, pointed toes and unsupportive soles can all contribute to over-pronation.
The right shoes Choosing pointe shoes that truly fit and support your feet in every specification (shape, size, width, vamp and shank) can make bunion development less likely. You still have to guard against over-pronating throughout your training, of course. If you’ve already developed bunions, limit pain by making sure your shoes aren’t too tight or stiff around the big toe joint. Ask your fitter about using spacers to realign the big toe to help stop hallux valgus from getting worse.
Choose your street shoes carefully, too. Properly supportive shoes will help protect you from over-pronation outside of dance class. If you have a strong family history, or are starting to see bunions develop, seek a consultation with a podiatrist and consider custom-made orthotics. Contrary to popular misconceptions, these orthotics don’t have to be heavy and uncomfortable. They are simply special insoles for your street shoes that discourage over-pronation.
Joint pain not always bunion Dr. Schoene sees dancers who confuse hallux valgus (bunion) with hallux limitus or rigidus. In hallux limitus/rigidus, the first metatarsal bone is longer than normal and elevated, which makes it hard to flex the foot fully into a demi-pointe position. This condition results from inherited foot structure and/or trauma to the big toe joint. Like hallux valgus, it may get worse from over-pronation and badly-fitting shoes. Hallux limitus/rigidus can be very painful and debilitating.
With careful training and appropriate footwear, bunions aren’t inevitable!
Dr. Lisa M. Schoene
Dr. Lisa M. Schoene, DPM, ATC, FACFAS, is a triple board certified sports-medicine podiatrist with a specialty in dance. She treats dancers at every level, from beginners to professionals to teachers, and is an expert at evaluating pointe readiness, teaching injury prevention, and treating injuries that do occur. In addition to working with clientele including The Joffrey Ballet, Hubbard Street Dance and many other companies, studios and athletic teams, Dr. Schoene is a prolific writer, teacher and lecturer on sports and dance medicine. Based in the Chicago area, she practices at Gurnee Podiatry & Sports Medicine (www.Dr.Schoene.com).