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BUNIONS: A COMMON FOOT AND ANKLE PROBLEM, Especially If You Are “Dancing With The Stars”
George E. Quill, Jr., M.D.Louisville Orthopaedic Clinic - Louisville, KY
There is a lot of confusion and misrepresentation about bunions in the world today, especially because this is such a common physical malady. The term bunion refers to a prominence at the inside aspect of the forefoot near the base of the big toe. The term bunion actually refers only to a prominence here, and the correct medical term is hallux valgus.
The hallux valgus deformity consists of a malalignment of the first metatarsophalangeal joint associated with lateral deviation of the great toe towards the second, prominence of the inside part of the forefoot, and an increased width of the front of the foot compared to the heel. The bunion problem often causes a problem with shoewear and activity levels.
Bunions are very common in dancers, and just because one has a bunion does not necessarily mean that it needs to be fixed. Many bunions are painless. Many bunion deformities are non-progressive.
There are other clinical entities that are lumped into the category of “bunion” that really refer to either an arthritic condition or a “knuckling down” of the dancer’s forefoot.
Dancers obviously spend much more time on their feet than do most sedentary people. Dancers usually have a very strong foot and rarely do they require surgery for a hallux valgus deformity unless it hurts daily or, even in the absence of daily pain, is rapidly progressive or causing impingement of other structures in the front of the foot such as hammertoes and calluses, corns, and neuromas.
Nonoperative treatment for bunions in an active dancer would consist of taping, shoewear modification, and gentle range of motion exercise. Nighttime splinting and many over-marketed podiatric treatments have never been clinically proven to improve the clinical course of bunions in dancers.
For daily pain that gets in the way of dancing and/or for progression of deformity, there are outpatient surgical remedies for hallux valgus. These are done in the outpatient surgical setting with twilight sleep and nerve blocks that keep patients very comfortable.
Many of the horror stories one hears about bunion surgery can be avoided by choosing your healthcare provider carefully.
In short, just because one has a bunion does not necessarily mean one needs surgery, especially in an active dancer who can often get by with nonoperative care. Bunion surgery is for patients who are experiencing daily pain, for patients who have noticed the size and shape of the bunion continues to get larger over time, and for patients and dancers who can no longer find shoes to fit the size of their bunion or in whom the deformity prohibits comfortable pursuit of their dancing passion.