Thanks to the nature of our sport, we can suffer some painful foot conditions at times. One of the more common ones: the bunion. A bunion is an (often unsightly) protuberance at the base of your big toe. It forms when the metatarsophalangeal joint (MTP for short) is stressed over a prolonged period of time, causing the first metatarsalto turn outward and the big toe to point inward. The resulting protrusion can be painful—especially when it chafes within shoes. Some people can also form a bunion at the base of the pinky toe, as well, known as a bunionette (and sometimes misdiagnosed as a Tailor’s bunion).
Identifying Symptoms of Bunions
Bunions are fairly easy to identify. If you have a knobby protrusion at the base of your big or pinky toe, it’s likely a bunion. Your doctor, a podiatrist, or a physical therapist can verify your hunch during an exam. He or she may want to take an X-ray to determine its severity. You may also be alerted to the formation of a bunion if the protrusion starts rubbing against shoes causing discomfort and pain.
Bunions can be particularly painful for runners, both because running in the wrong shoes can exacerbate them, but also because they can lead to other foot problems. If you start to unconsciously shift your weight off the painful big toe as you run, you may develop discomfort in the ball of your foot. The big toe can dive over or under the other toes, causing corns or hammertoes to develop.
Common Causes of Bunions
There may be a hereditary element to bunions, and having low arches, flat feet, or loose joints can increase your risk of developing them. In some cases, arthritis is to blame. Lack of strength in the muscles of the foot and wearing narrow, pointed-toe footwear are also causes. This is thought to be one of the reasons women tend to get bunions more than men—they’re more likely to wear tight, high-heeled shoes. But even ill-fitting running shoes can be to blame, says Ray McClanahan, D.P.M., podiatrist at Northwest Foot & Ankle in Portland, Oregon.
Most running shoes have a tapered toe box (that is, they get narrower at the toe) as well as a slightly elevated heel. Wearing a running shoe with a significant drop (the height difference between the heel and forefoot often measured in millimeters) year after year can be a recipe for bunions, says McClanahan, who is a long-distance runner. McClanahan often references what our feet looked like when we were babies: Our toes are splayed out wider than the rest of our foot. Interestingly, shoes for babies are still designed to accommodate this natural foot shape which aids a child’s balance when learning to walk. “But at two years old, we literally start making miniature versions of adults’ shoes,” he says. “We start deforming our toes.”
Indeed, in shoeless societies, deformities like bunions, hammertoes, and plantar fasciitis, are so rare as to be non-existent. (If you doubt this, take a look at Dr. William A. Rossi’s seminal article called “Why Shoes Make Normal Gait Impossible,” in which he lays out how, in industrialized societies, foot deformities are directly caused by faulty footwear.)
Though you probably wouldn’t classify your running shoes as high heels, take a closer look. Most running shoes have a 2:1 heel-to-forefoot ratio. But what that does over time is shorten your Achilles tendon, which in turn weakens and flattens your arch. This—coupled with a tapering toe box that squashes your big toe into the space that should be occupied by the second toe—can create… you guessed it: a bunion.
Bunion Pain Relief and Treatment
Treatment for bunions starts with changing your shoes. High heels are definitely a no-no, as they tip the body’s weight forward, forcing your toes into the front of the shoes. Applying ice to your bunion and/or using acetaminophen, ibuprofen, or even cortisone injections can help control the pain in the short term. Using moleskin, gel-filled pads, or shoe inserts for arch support may also help.