The runner's foot--life with bunions.

Runners' feet are never pretty, but some problems can go far beyond aesthetics, namely bunions. Technically known as hallux valgus and personally known to as many as 50% of American women and somewhat fewer men, a bunion is an enlargement of the metatar-sophalangeal joint or big toe joint. A result of repetitive pressure, the big toe joint moves out of place, enlarges, and causes the toe to turn toward the smaller toes. The joint can be significantly stiff, swollen, and extremely painful. The disfigurement can also occur at the little toe joint.

A bunion forms when poor biomechanics or excessive force causes disruption in the joint as it carries your weight. The instability in the joint can result in cumulative effects that cause the deformity. The type of foot that is prone to bunions, along with its poor biomechanics, is inherited. Other causes of bunions are the result of foot injuries, neuromuscular disorders, congenital deformities, and occupations and avocations (like running) that put extraordinary stress on the feet.

Conservative care includes padding and taping to reduce stress and pain, non-steroidal anti-inflammatory medication, steroid injections, icing, physical therapy, ultrasound therapy, and orthotics to control foot mechanics. Surgery is often the option of last resort. A bunionectomy is the surgical procedure in which the bony enlargement is removed and the alignment of the toe joint is corrected.

Research recently published in the Journal of the American Medical Association should give bunion sufferers more confidence in choosing surgery. More than 200 Finnish men and women with mild to moderate bunions were randomly assigned to Wave orthotics, corrective surgery, or no treatment. After one year, those who were assigned to surgery had less pain and deformity, fewer footwear problems, and the best overall satisfaction compared to the other two groups. Orthotics were helpful in reducing pain for up to six months.

This is not to say that all feet with bunions ought to be rushed off to surgery. Some bunions are relatively painless and conservative care can be helpful in preventing progressive worsening of symptoms. Choosing shoes with a large toe box can be helpful if you already have bunions, and can be extremely important in preventing the development of bunions in the first place. However, if you have bunions that are painful, this research can be reassuring if you've considered surgery. For more information on bunions and other foot problems visit the Web site of the American Pediatric Medical Association at www.apma.org. (Journal of the American Medical Association, 2001, Vol. 285, No. 19, pp. 2474-2480)