Bodyworks: Bunion (Hallux valgus)

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
You’ll feel tenderness over the inner side of the joint between your first metatarsal (MT) and big toe, or hallux, and notice that the end of the toe starts to point outwards, forming an angle of up to 90 degrees with the MT. Pressure of any sort over the joint can cause both redness and pain.

Signs
The deformation is obvious, and underlying this will be wear and eventual arthritis of the first metatarso-phalangeal (MTP) joint. The space opened out by the splitting of the joint is filled by a thick-walled bursa – the bunion. Bunion-sufferers often lose their transverse arch under the metatarsal heads, which exaggerates the problem.

Medical investigations
An x-ray is unnecessary, and blood tests will only exclude differential diagnoses.

What else could it be?
Gout, and occasionally other rheumatic conditions, may arise within the first MTP joint.

Self-treatment
Correcting the loss of the transverse arch with a metatarsal pad, or wedging the first and second toes apart with cotton wool will delay the progression of the condition. Protecting the bunion with felt or foam pads, if your shoe is large enough to permit it, will ease your pain.

Medical treatment
The worst bunions can ultimately be corrected only by surgery. Various operations have their proponents; none prevents some disability in terms of mechanical efficiency, but all should leave you pain-free! Meanwhile, anti-inflammatory drugs, cortisone injections, mobilisation and exercises will give some relief.

Can you run through it?
Running through bunions without podiatric modifications is possible, though you will probably feel some pain, which is likely to progress over the years.

Recovery time
After surgery, you should be able to begin light training after six to eight weeks, and be on the road in 12.


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Discuss this article

Has anyone had a bunion operation and if so how long was it until you were running again. I am having both feet done in August and need a training programme to get me fit again afterwards. Can you help
Posted: 08/06/2003 at 14:25

from what i understand, and from people who have had them done it will be a good 6-8 wks before you should think about walking any great distance! what did the surgeon reckon? it varies depending on the type of bunion op though and a load of other factors. having em both done i couldent see any activity for 4-6 bwks. swimming and stuff would prob be a good measure in between.
good luck and hope alls well.
Posted: 11/06/2003 at 21:32

oops, have just seen this message, but for all those people having bunion ops (lovely!!), I had both my feet done at the end of November. I was only able to potter around for 6 weeks, when the plasters then come off. 4 weeks after that I was running again regularly and have had no problems since. the op is well worth it - I found post-op not as painful or limiting as I'd imagined.
Posted: 12/03/2004 at 17:07

Niks, thanks for your note. I too have now had the operation. I had it done in August and am up and running too. I also stongly recommend the op to those bunion sufferers out there.

regards T
Posted: 18/03/2004 at 17:48

Have just done 18m at the end I had to walk as I have a painful bunion. It was agony - am so depressed as doing London this year - does anyone have any ideas ?
Posted: 12/03/2005 at 09:44

Hi Fifi
As you know I had my bunions removed in August and I am sad to say only one was sucessful, the other still being painful. But I am able to run without too much pain by doing the following....If you go to Boots the Chemist they have a toe divider, it is like a silicone thingy that you put between your big toe and next toe. It helps to put the big toe where it should be. As a runner you would need to also tape it into place with surgical tape. Make sure you tape your two toes togher horizontally with the silicone in the middle as well as going over the silcone and up you foot a little way to stop it popping out. Hope that makes sense! If not give me your address and I will draw a picture.
Posted: 14/03/2005 at 10:02

I have a bunion and gout attacks in my big toe and wondered if anybody has had the same experience? I see a specialist in june and can run gently at the moment.
Posted: 24/05/2006 at 17:34

Does anyone have any advice for a sufferer of constant blisters on the bottom of the toes. Not me, but my hubby. He's really struggling to get his running off the ground. Does a couple of sessions but then has to stop till they heal! Any advice welcome. Thanks to you all out there.
Posted: 27/07/2006 at 13:25

Is anyone still looking at this thread? In case they are, I'd like to hear from anyone who has had a bunion op, where the original condition included a collapsed transverse arch - i.e. the arch across the ball of the foot. My bunion is quite severe but does not in itself cause me much of a problem. However, the collapsed transverse arch causes a painful callous under the ball of the foot which is severely restricting my running. Can the op to correct the bunion also effectively rebuild the arch? I have so far spoken to one orthopaedic consultant who was pretty negative about it.
Posted: 27/02/2007 at 15:55

Steve,
Just came across this thread - I am about to see my GP having read of somebody having similar symptoms (increasing arch pain, arthritic bunion).
I will let you know if it's a collapsed transverse arch, but I certainly suspect now that the root cause is the bunion; I've had it for several years but it's obviously time for action. The arch pain has recently become permanent.

Tracey C,
Are you there ? How are the feet ?

Posted: 28/02/2007 at 18:37

Just had my bunion done a month ago, although not with the collapsed arch It has not been painful just waiting for the swelling to go the foot is looking good with no big lump on the side the worst problem is being stuck indoors.
Looking foward to buying some new shoes and getting back running
Posted: 05/03/2007 at 09:40

Hi guys

 I see this is an old thread but I'm told I need to have surgery on both feet - both are bent about 90 degrees but not crossing the toes, bump is very big and it's very often painful, though I just try to deny it and I'm still running and hoping to do my first trail marathon in June 09 but don't know when the surgery will happen yet.  I don't have any arch problem except a little burning in the arch and it felt tight for a while recently - I hope it's not what happens before it collapses?  I would like recommendations (possibly with names & contact details) of any good surgeons or consultants - my gp referred me to a podiatrist who was ready to do the surgery in September but I stalled as I was scared.  Did some research on the internet and everyone said don't touch podiatrists with a barge pole and orthopaedic surgeons are the only way to go.  Completely lost and terrified of my feet being ruined - I'll die if I can't run!!

Any help and advice about the surgery and ways to keep fitness and strength levels up without jeopardising recovery much appreciated!

Thanks! KM


Posted: 27/12/2008 at 22:18

Hi y'all

I am having a double bunionectomy soon, have prepared as much as possible for this by getting as fit as possible.

I can see that this is an old thread and wondered if any of the contributors would spare a few minutes to update with long term results on bunionectomy and running?

it would be really helpful to know how long it was before you could start running again, when you got back up to pre-op times/distances and any good ideas you had or things you would suggest that I avoid?

thank you in advance.

EdnaBucketEatingChocolate,(less lately to control weight for op) 


Posted: 21/09/2009 at 14:15

just a small update, on this old thread... just in case anyone researches this subject...

the bunion op is the best thing I have ever ever done.  My feet have stopped hurting, I have gained arches (flat previously) in both my feet.  The sciatica has lessened to the point where I hesitate to say it has gone, the  hard skin and major callouses that I used a foot knife to remove have fallen away and I have feet like a baby's.

the toe nails have gone back to normal.

I got a new gait, which means that the muscles in my legs are working properly.  I had to learn to walk properly in the new gait - this has exercised all the leg muscles in a new way.  I have had to go back to the beginning for my running and dancing as my feet act differetnly.  I am not running as much yet, as the leg back and feet muscles are acting differently and some need to build up.

my walk is no longer slightly twisted, I am delighted.

I am at op +20 weeks and am back to kayaking, running, dancing, walking (the dog), rambling and I have new shoes.

This is the best £12K that the taxpayers funding the NHS have ever spent and I am eternally grateful.

if anyone is suffering and is offered a double bunionectomy, get as fit as you can, plan to be immobile (more or less) for 6 weeks, and go for it!

thank you NHS, thank you taxpayers of the UK.

EBEC 


Posted: 14/07/2010 at 07:45

EBEC, that all sounds very positive.

Are your feet narrower now?

I ask because although one of my bunions is only just starting to be painful when running (perhaps due to arthritis, which I also have in my fingers), I am thinking about having the op because I have F-width feet. The only running shoes I can squeeze into are NB D-widths, and then I have to cut a slash in them to accommodate the bunion.

It would be great to have a choice of shoe brands! 


Posted: 14/07/2010 at 11:14

Hi

 my feet used to be like this, left foot heel is an A fitting (narrow) and the across the ball of my foot it was an E fitting.  the right foot had an A heel and a C fitting at the front.

lived in trainers, or could find one or may be two pairs of really unfashionable shoes at horrendous prices.

Last week I tried on 20 pairs of shoes and could have bought them all, heaven..... the difference is that in the old days when I put my feet together and looked at them, they touched at the bunions and the heels and the ankles, and there was a big gap along the sides of the feet and therefor between.

Now I look down and my feet touch together from the heel to the big toe joint.   the scars are neat (thank you surgeon) and are hidden by the shoes.

even the little toes are not rubbed.....

saving up for some new running trainers....

and still delighted.  Obviously the results will vary from surgeon to surgeon and across patient range depending on what work needs to be done and which op they choose.  I had the osteotomy where they cut a triangle of bone out to straighten it, 3 on each foot.

worth researching what the surgeon says to you, cos I think they get a slightly different result for each type of op, trying to think of a negative in all this?  cost of new shoes - binned all the old ones so they wouldnt pull my feet back into the old shape?  being housebound and borrowed mum's wheelchair? led to insights about how I should act towards disabled people... no bath or shower for 6 weeks? hey that was fun for me and my husband  nope, .......that's about it...

the running is seriously back to beginners.... new gait being experimented with...

happy to help 


Posted: 14/07/2010 at 11:26

Thanks, that's very helpful. Just to be able to walk into an ordinary shoeshop and try on ordinary shoes must be amazing!

All the best for your running comeback...

This is beginning to sound possible, though it would require some serious planning as we live in the back of beyond and husband doesn't drive. I suppose I could live downstairs for 6 weeks, work on laptop (office is upstairs), get to downstairs bathroom on all fours (or crutches perhaps).

I'll report on here if I do have the op.

Meanwhile would be interested to hear of any other experiences.


Posted: 14/07/2010 at 17:41

Chouette,

they get you up walking the day after the op, and when I whinged that I couldnt do it, I found out why my hubbie calls them physio-terrorists.  I had 3 breaks in each foot but I was up and at 'em.... lovely painkillers....

I was walking from the day after, they gave me some lovely geisha like shoes, where all the body weight goes on the heels and effectively I walked with my toes in the air, I had to negotiate stairs before I was allowed home, and had to show that I could function at home.  I managed the stairs in my terraced house, steep but we had one handrail. 

My husband did most of the cooking until I used the office chair to whiz around the ground floor when I was not bothered to use the crutches.

I bought a tea trolley off ebay and we (he was also on crutches) moved the tea tray, dinner plates, washing to the outside, etc around with that, (£20.00) .

I spent most of my time playing farmville on Facebook.

I could walk slowly, wasnt able to drive, used provided wheelchair in ASDA, tesco etc, and borrowed my elderly mum's wheelchair for trips out. returned to driving at week 6 1/2.

Each week I was more mobile, no plastercasts, dressings off after 2 weeks,

but depends on what op your surgeon wishes to perform for the best outcome for you.  I googled it and there are about 3 different types,  this is one of those things where it helps to know, but small word of warning, I chose not to continue to watch the video of an op like mine, cos the puke made the keyboard sticky....   

forward planning is better than reacting when things are happening ....


Posted: 15/07/2010 at 10:58

 Great to hear about the walking - I was imagining the muscles in my lower body melting away as I sat up in bed doing biceps exercises in a desperate bid to keep something firm.

I thought the plaster must be on for 6 weeks because of your comment on no bath or shower.

Walking on my heels is an exercise I do anyway - good for balance. Can see that would come in useful.

And thanks for the tip about using the office chair for indoor transport, much better than a wheelchair.

I quite like watching operations usually...


Posted: 17/07/2010 at 16:23

Hiya, this is my first post, so please be gentle!

I'm new to running (week 4 of a run/walk programme) and although I am loving it, I've started getting really bad pains in my big toe joints when walking/resting (I haven't noticed it yet while running...probably because everything else hurts so much I don't notice!). Both my big toes point towards my other toes, and the I have huge "knuckles" at the joint, and have done for years, despite not wearing heels or narrow shoes.

 I didn't think they had gotten any bigger,  but now that this pain has started, and I'm finding it harder and harder to find any shoes (including trainers) that fit, is this something I should see a doctor about...is an op the only way to fix this? They've never been diagnosed as bunions, but I've never had them looked at, because besides the lumps, they've never caused me any problems.


Posted: 05/08/2010 at 14:18

I've got bunions on both feet too, and for the women in my family it is almost 100% hereditary. I say that because I started developing the right bunion at age 6 and have never worn narrow or high heeled shoes. I have run all my life and now just into my early 30's I am starting to get pain. The pain is not really bad when I am running, however often gets unbearable at night. I've been reading everyone's experiences of surgery and it seems that finding the right surgeon is the way to go! 

 My main problems are that I'm pretty sure Australia does not cover bunionectomies (meaning at least 18 months wait for a public hospital, or out of pocket cost of $1000's), and also when on earth I can take 6 weeks off work (am a junior doctor so spend every second on my feet).  Maybe one day, perhaps when I retire!! 


Posted: 13/02/2011 at 11:04

Hi all you runners with bunions out there

 I've suffered with a bunion on my left foot for well over 10 years now but have managed to run a 3hours 29 mins marathon with it, although in 2006!  I'm now thinking of having an op on this bunion but want to know if it will be successful and will I be able to regain my fitness and get my original speed back.  My bunion causes injuries such as achilles tendonitis, calf strains and bits of sciatica with lots of stiffness after runs sometimes.  Will all these conditions be allievated do you think?  Another lady runner in my club had her bunion operated on 18 months ago and hasn't looked back but she is over 60 and tends to run recreationally rather than racing nowadays.  But I want to carry on racing for as long as I can, I have just recently had my 50th birthday and would love to start winning category prizes!

Any advice/comments would be welcomed.


Posted: 09/06/2011 at 10:29

hi shazza,

  im almost 35 and have had bunions from bout the age of 14. They run in the family.  i have flat feet and had a chevron and aikin osteotomy on my left foot in dec '10.  I can say its the best thing ive ever done.  Before surgery i was getting shin splints when i first started running but now i can run for miles and have no problems.  i went against advice and increased the mileage quite alot in the first few weeks without any problems.  I dont race. (my snail pace wouldnt beat anyone) im quite new to running only started 2 months before the surgery had 7 weeks out then started up again.

The hardest part is recovery. doing nothing is really hard.  i had a thick bandage and was walking out of hospital the same day.  They gave me a thick shoe where all the weight is on the heel.  I have 3 pins in my foot and really bad scarring but i dont care.   My feet were ugly to start with.  Now i can exercise for hours injury free!

the podiatrist at the hospital tried to put me off having the surgery and said that i could get it done later but ive since read that if you leave it too late then you will have to get the bones fused and that would mean less range of movement in the foot and you wouldnt be able to do certain things like step aerobics.

 i have pre-op for right foot in 2 weeks.  having the same done.   Dreading the weeks  on the sofa

 hth's


Posted: 09/06/2011 at 20:07

Thank you.

How long before I can return to running do you think, or anyone else think?


Posted: 13/06/2011 at 19:13

Shazza,

Are you sure the injuries you mention are caused by your bunion? Have you been told this by a sports physiotherapist?  Is the bunion painful when you're not running?

If you answer yes to all the above, perhaps it's time to consider the op. If not, get a physio to see if they can deal with the injuries (even if the bunion is an aggravating factor, there may be some other changes you can make to compensate).

Although I'm sure most bunion ops go well, there's a minority who wind up worse off.

Having googled the subject extensively, I've decided not to take the risk - at least, not until I'm in a lot more pain than I am now.
Posted: 13/06/2011 at 19:41

Hello all you bunion runners out there!

 I have bilateral bunions since I was a young girl. Love running. 

 Think my bunions are getting worse over the recent years...I do find it difficult to find shoes that fit properly. They seem to be ok for a few hours, but after long periods of standing, the bunions just become painful.

 I ran a 10k not too long ago, and my bunions hurt quite abit!

 Can anyone recommend which running shoes would best fit those with bunions and flat feet? Am I too young for surgery??  


Posted: 30/09/2011 at 20:44

I've just had twin bunionectomies. 28/5/12. Right foot needed a bit more surgery as had chickened out of op for too long. There is a steel plate in there but whether it stays in or what affect will have on walking, never mind running, is still to be found out. 

Had them done privately so no waiting. Also bad experience with local hospital ten weeks before, had me look for alternative care. In the end, they were much of a muchness. 

 I'm sat here in bed as loo is upstairs but dread having visitors as bedroom last decorated some twenty years ago plus with spare room filled to the gunnels , this doubles as general dumping ground. No way would I want less than true friends in here. Will have to hobble downstairs in that case.  

I'm not a runner but would love to take it up with, hopefully, straighter feet.  if only for fun runs though would like to do more. I'm 60 this year and not about to give in to old age any time yet. 


Posted: 31/05/2012 at 11:36

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