Bunion Management

What is a bunion?

• A bunion is localized, painful swelling at the base of the big toe due to bony overgrowth (Sheil, W).

What are the common signs/symptoms?

• Angulation of the big toe towards the second toe. 
• Inflammation of the big toe joint (pain, redness, swelling, and/or warmth at the base of the big toe joint).
• Reduced range of motion in the big toe evident with pain/limitation on demi-pointe.

What are the risk factors?

• Family history of bunions
• Individual anatomy (joint laxity, pes planus, limited mobility in the foot/ankle joints) 
• Reduced core/pelvic stability
• Impaired lower quarter strength 
• Poor technique
  • Excessive winging of the foot/ankle
  • Increased pronation (arch collapse) often due to lack of turnout from the hip
  • Leaning on the big toe en tendu, walking in turnout)
• Poor fitting flat shoes or pointe shoes 
• Starting pointe work too soon 

Can I prevent bunions from getting worse?

• Yes!

​What can I do to improve my bunions?

• Correct the big toe alignment. Taping the foot can help improve the alignment. Try to avoid using toe spacers between the first and second toes as it can weaken the muscles between the toes. 
• Ensure that your flat shoes and pointe shoes are properly fitted. Avoid toe boxes that are too narrow.
• Wear protective shoes outside of dance class. Avoid walking barefoot or wearing non-supportive sandals. 
• Focus on refining your technique. Avoid excessive winging of the foot, ensure adequate turnout from the hips, and avoid collapsing in the arch.
• Strengthen! Improve the strength of the muscles that control the big toe as well as the foot intrinsics, deep external rotators of the hip, and core musculature. 
• Improve the range of motion in the metatarsals, midfoot, and ankle with joint mobilizations and dynamic stretching. 
• If the big toe is inflamed, consider doing a flat barre and flat center.  Don’t dance through the pain! 
• Avoid starting pointe work too soon. 

References:
Shiel,W.Bunions(HalluxValgus). https://www.medicinenet.com/script/main/art.asp?articlekey=2552. Accessed April 4, 2020. 
Howell,L.Does Pointe Work Cause Bunions? https://www.theballetblog.com/portfolio/does-pointe-work-cause-bunions/Updated August 31, 2010. Accessed April 4, 2020.