|
|
Focus: Bunions
Russian Pointe Newsletter, March 2009 |
This article has been created in consultation with Chicago-based podiatrist and sports medicine specialist Dr. Lisa Schoene, DPM, ATC, FACFAS.
Got bunions?
This deformity is so common that some dancers, teachers and pointe fitters simply refer to the big toe joint as "the bunion joint," whether or not the deformity is present in an individual foot.
But what are bunions and how do you get them? From your grand plié or your grandmother? Can you avoid getting them if they run in your family?
Bunion genetics
You may have heard that bunions are an inherited condition. In fact, it's a foot type that is inherited, making you predisposed to developing bunions. Dancers with a family history of bunions don't always get them. Dancers without family history can get bunions, too.
Whether or not you inherited a tendency to get bunions, your dance training may make them worse or more painful, and it may make them develop sooner. Fortunately, though, you can avoid the primary factors in your training and footwear that contribute to bunion development. |
What is a bunion?
 The word "bunion" actually refers to the bump that develops on the big toe joint. The bump is just one part of the condition known as hallux valgus. In hallux valgus, the tip of the big toe drifts toward the little toe. This makes an angle at the big toe joint, which should be basically straight. The joint becomes enlarged, inflamed and often painful. Tight shoes and heavy use of the feet tend to make the pain worse.
Rolling in
The key to hallux valgus development is overpronation ("rolling in"). The foot naturally rolls inward and outward when you walk, run, climb or jump. Overpronation happens when the foot rolls toward the big toe too much, too often and at the wrong times. This makes the first ray (the bones leading to the big toe) unstable, and the big toe joint overly mobile. | |
|
Faulty technique
People who inherit a tendency toward hallux valgus have feet that naturally tend to overpronate. Unfortunately, many dancers without family histories get an "artificial bunion gene" in ballet class.
How? Forcing turnout, by pushing the toes outward, inevitably leads to rolling onto the big toe joint. This overpronation affects the foot regardless of whether or not your mother, grandmother or aunt has bunions.
Although bunions may emerge during pointe training, pointe shoes aren't always to blame. As you get older and train more intensively, any stresses to the body have more impact, including overpronation. Even dancers who never go onto pointe may have premature bunions. | |
Joint pain not always bunion
Dr. Schoene sees dancers who confuse hallux valgus (bunion) with hallux limitus or rigidus. In hallux limitus/rigidus, the first metatarsal bone is longer than normal and elevated, which makes it hard to flex the foot fully into a demi-pointe position. This condition results from inherited foot structure and/or trauma to the big toe joint. Like hallux valgus, it may get worse from overpronation and badly-fitting shoes. Hallux limitus/rigidus can be very painful and debilitating. | |
|
Shoe choices
Nonetheless, pointe shoes can contribute to bunion development, for two reasons. First, dancers who overpronate on flat often "wing" (roll toward the big toe) on pointe. Second, if your pointe shoes don't fit properly, there is even more pressure and stress on the big toe joint.
If the toe box is too tapered or too narrow, the toes are squeezed together. The big toe is pressed and angled toward the other toes. Then, the weight of the body is absorbed at an angle, instead of vertically through the foot to the end of the toes. This mimics overpronation and can cause the same problems, including bunions.
This can also happen with a toe box that is too square or too wide. It just happens in a different way. With too much room in the box, the toes can drift into any number of inappropriate positions. It is most likely that they will collapse so that the weight is pressed into the big toe joint.
To a lesser extent, street shoes or other dance shoes can stress the feet in similar ways. High heels, pointed toes and unsupportive soles can all contribute to overpronation. |
 The right shoes
Choosing pointe shoes that truly fit and support your feet in every specification (shape, size, width, vamp and shank) can make bunion development less likely. You still have to guard against overpronating throughout your training, of course. If you've already developed bunions, limit pain by making sure your shoes aren't too tight or stiff around the big toe joint. Ask your fitter about using spacers to realign the big toe to help stop hallux valgus from getting worse.
Choose your street shoes carefully, too. Properly supportive shoes will help protect you from overpronation outside of dance class. If you have a strong family history, or are starting to see bunions develop, seek a consultation with a podiatrist and consider custom-made orthotics. Contrary to popular misconceptions, these orthotics don't have to be heavy and uncomfortable. They are simply special insoles for your street shoes that discourage overpronation.
The bottom line: With careful training and appropriate footwear, bunions aren't inevitable! |
| NEXT MONTH, read Dr. Schoene's specific recommendations for exercise, therapy and footwear, to keep your big toe joint in good shape! |
 Dr. Lisa Schoene, DPM, ATC, FACFAS
Special thanks to Dr. Lisa Schoene for her expert guidance on this month's Focus article. In over 18 years of practice, Dr. Schoene has worked with numerous dancers, Olympians and other elite athletes, and consulted for dance companies including Joffrey, Hubbard Street and Inaside Chicago Dance. She is a prolific author on foot health, and a media spokesperson for the American Podiatric Medical Association, including interviews by many national publications. She practices in the Chicago area, at Gurnee Podiatry and Sports Medicine. | |
|
|
|
|
|
