What is it?
A bunion is a condition where there is a gradual change in the anatomy of the great toe, leading to a painful and permanent deformity over the side of the digit. The condition seems to be worsened with pointed or tight-fitting shoes due to the pressure applied. As a result, dancers, particularly ballet dancers, are prone to being affected.

Symptoms
What is mainly noted in this condition is a painful, swollen red area over the deformed joint of the great toe that is tender to touch. On occasion, individuals may also experience numbness or a burning sensation over the area due to irritation of the surrounding nerves. Because the great toe is angled inwards, irritation of the skin may occur and can lead to blisters or bursitis (inflammation of the bursa, a protective overlying sac) at the bunion site. In severe and long-standing cases, the deformity can be pronounced enough to cause overlapping toes and arthritis (inflammation of the joint), which can cause further discomfort. Individuals with bunions experience pain with walking and activities that require pushing off of their feet.

Sports Medicine Evaluation and Treatment
Diagnosis is typically made on visual inspection and exam of the foot by a physician. X-rays can be helpful to assess the extent of deformity and presence of arthritis. Treatment involves rest, intermittent ice application, and antiinflammatory medications (such as ibuprofen or naproxen). Gel spacers between the toes, orthotics (either over-the-counter or custom-made), and bunion cushions can also be helpful for symptoms. Modifying activities that cause pain and changing foot wear to shoes with more toe room are advised when possible to prevent exacerbating the problem. Return to activity can be to tolerance of the symptoms. For those with severe pain even with walking or failure of conservative measures, a referral to see an orthopedic specialist for surgery may be necessary. Although the surgical procedure can vary and depends on the individual as well as severity of the bunion, it can usually be done as “same-day” surgery without general anesthesia. Because the procedure involves straightening and realigning of the bones and joint surfaces, typical healing time ranges from 6 to 8 weeks and requires the use of crutches for several weeks The physician will direct when it is safe to return to activity, once proper healing has been achieved.

Injury Prevention
Inserts and spacers may not be effective for prevention, especially in older patients or those with more severe deformities. Wide shoes, especially near the ball of the foot, may prevent bunions from developing. Children who wear shoes that are too small have a higher risk of developing bunions.

Return to Play
Return to sport after bunion surgery usually takes several months. If athletes find non-surgical treatments that are effective, sport participation is not restricted. . In general, dancers should avoid surgery for bunions until retiring from dance since normal post-surgical loss of range-of-motion at the joint may make it impossible to do some dance moves (e.g., demi-pointe).

AMSSM Author Members: Dr. Jason Brucker, Dr. Craig Young

References
Wülker N, Mittag F. "The treatment of hallux valgus". Dtsch Arztebl Int. 2012 Dec;109(49):857-67.
Ferrari J. "Bunions". Clin Evid (Online). Mar 11 2009; 1112.