There are a number of foot and ankle conditions that trouble runners such as bunions. Often these can be prevented by proper technique and appropriate muscle stretching and strengthening. If a problem isn’t quickly resolved it is important to have a proper orthopaedic assessment to prevent minor niggles developing into major problems.  If surgical treatment is required make sure you maximise your chance of a quick and lasting recovery by asking for keyhole or minimally invasive surgery.

What is a bunion?

A bunion refers to a swelling affecting the main big toe joint. There are two main types, one has a stiff but relatively straight toe and is an early form of arthritis, whilst the other has a less stiff toe but the big toe changes shape and points towards the little toes and is due to joint instability. Runners mainly get the first type and experience pain in the joint, rubbing on shoes and swelling.

What causes bunions?

Bunions are caused by muscle imbalances within the foot and can be exacerbated by muscle imbalances in the leg. If you look at your hand, particularly around the thumb (big toe equivalent), there is a lot of muscle around the bones. These muscles control the fine movements of the fingers and get a regular work out whilst writing, texting, doing up buttons etc. The same muscles exist in the foot but hardly ever get used because we wear shoes and walk on artificially flat floors, this causes the muscles to weaken and instability in the joints. In societies that don’t wear shoes there are hardly any bunions.

When should I seek treatment for my bunion?

If you have a bunion that limits your enjoyment of running through pain or rubbing on shoes you should seek the advice of an Orthopaedic surgeon with a special interest in foot and ankle. To ensure you’re in the best hands you should look for someone with fellowship training in foot and ankle surgery and who is a member of the British Orthopaedic Foot and Ankle Society.

What can be done about bunions?

If caught at an early stage it may be possible to ease the pain and prevent arthritic bunions from growing with some very specific stretching exercises. These exercises should not be confused with general stretching that all runners do, or should do prior to training. Injections have been shown to have very short term results and can damage the joint further and should be avoided. If the bone overgrowth is too great it can be removed through keyhole surgery with patients able to get back to running from as early as 2 weeks after surgery. More severe joint damage can be treated with a joint replacement operation, again with patients able to return to sport from as early as 2 weeks. In very severe cases it may be necessary to fuse the joint although this should be avoided as it is likely to significantly affect running.

The second type of bunion  where the toe moves freely but isn’t straight can also be treated through keyhole surgery but takes longer to recover from.

Keyhole surgery is the latest advance in bunion surgery, with very few centres offering the service. Richard Freeman is an expert in foot and ankle keyhole surgery and regularly teaches internationally on the subject.  Appointments with Mr Freeman can be booked online.

– Mr Richard Freeman, Consultant Orthopaedic & Trauma Surgeon, Spire Gatwick Park Hospital