Pain in the Bunion
Swelling on your big toe can force you to stop running if you’re not careful.
Left untreated, a bunion can become very painful and debilitating.
Hilda Beauregard was 18 years old when a friend told her the bump protruding from the side of her foot at the base of her big toe was called a bunion. “I have my mother’s feet, and before that had just assumed everyone’s feet were like mine,” she says. Beauregard started jogging when she was 21. Her bunions never caused her pain through more than 30 years of running including 28 marathons. “I went for motion-control running shoes because I knew I was a serious pronator. I replaced them often, always making sure the shoe didn’t have a stiff upper where it came in contact with the bunion. I sometimes bought men’s shoes because they’re wider across the forefoot.” She admits her job helped her manage her bunions and her foot health in general – for many years Beauregard worked at Running Room stores in Ottawa.
Stephen Hartman, ceo of the Canadian Federation of Podiatric Medicine ( cfpm), says a proactive approach is essential for any runner who has or is predisposed to bunions. Hartman, a chiropodist who runs a private clinic in Waterloo, Ont., says it’s important to seek professional help when bunions start causing pain. He says a bunion is formed when misaligned big toe joints swell and become tender, causing the first joint of the big toe to slant toward the midline of the body and the second joint to angle toward the other toes on that foot.
Hartman says there is usually a hereditary factor in the formation of bunions and it comes from pronation. “We need to pronate to absorb shock,” he says. “But some people overpronate, which is the arch flattening too much or at the wrong time during the gait cycle.” Footwear, occupation, age and weight also play a role, Hartman adds.
Bunions may become more prominent as a person ages. Left untreated, a bunion can become very painful and debilitating. When runners modify their gait to avoid aggravating bunions, these form changes can cause injuries to other parts of the body – the knees, hips and back, for example. “Runners with bunions usually need a very stable running shoe that controls pronation, and that’s solid through the heel to help stabilize the ankle. Runners may want to modify their running and try to run on softer surfaces. Toe stretches and stretching in general are useful. Orthotics can be very helpful and are often prescribed to help control pronation,” Hartman says.
Ottawa podiatric surgeon Joanna Faloon, a former elite canoeist and kayaker who also ran for decades, stresses that everyone’s foot is different. But she believes one of the most common mistakes among runners is to focus exclusively on their running shoes. She says to promote stability and balance, all other footwear should have, among other characteristics, a stable heel counter and a heel height of at least 19 mm, good longitudinal support, and a generous toe box without any seams on or near the bunion. “You need to take good care of your feet all the time, not just when you are running,” advises Dr. Faloon.
Experts agree surgery should be a last resort. Surgical correction involves realignment of the bones of the big toe and sometimes adjacent toes. “If runners don’t address the pronation problems that caused the bunion to form in the first place, the bunion may come back,” Hartman cautions.