By Robert Weiss, DPM
Recently this winter season, we have been seeing athletes with bunion pain including skiers, hockey players, basketball players and those involved in all types of running sports.
A bunion is a painful swelling of soft tissue and bone enlargement over the inner side of the ball of the great toe joint. It also involves the metatarsal head behind the 1st toe joint.
As the deformity progresses, the joint becomes arthritic. This often results in pain accompanied by the inability to wear shoes and walk comfortably. The longer one waits, the more difficult (due to the arthritic changes) it is to correct. The arthritis can break down cartilage and destroy the joint. As a bunion becomes severe, the distance between the first and second metatarsal bone is greater than that of a mild bunion. The big toe rotates toward the other toes making them contract into hammer toes. This, in turn, creates more deformities of the forefoot.
My clinical experience has found that the largest majority of people have a short 1st toe joint compared to the second toe. This creates a mechanically imbalanced foot as it rolls too much off the 1st toe joint. There are a number of corrective procedures depending on the degree of severity and deformity. The correction is based on the biomechanical principles of realignment for improved functional control with an orthotic. We have been successful with our patented orthotics and at times it is helpful to go to a wider width shoe. Many times a shoe stretcher that has holes around the front of the stretcher where a metal nob can be placed to pocket-out the enlarged bunion area. In severe cases, bunion surgery is warranted. But early detection and conservative therapy may help.
Dr. Robert F. Weiss is a podiatrist specializing in foot and ankle surgery with a practice in Darien, affiliated with Stamford Hospital and member of Stamford Health Medical Group-Foot & Ankle Institute. A member of the Medical Advisory Committee of the 1984 and 1988 Olympic Marathon Trials, he is a veteran of 35 marathons.
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