Everything You Need to Know About Bunions

"Dancing is the poetry of the foot." - John Dryden

          When it is time for a musician to perform, he or she takes out an instrument, plays it for the length of a lesson or rehearsal, and then carefully returns it to its case to let it rest until the next time it is needed.  When a dancer needs to perform, the body becomes the instrument, and after the class or rehearsal, the body cannot be allowed to rest because it is used constantly.  A dancer’s feet are one of the most abused parts of his or her body and cannot be rested since they are relied upon to move the body from one place to another.  It is for this reason that foot problems are a major concern – feet are not a part of the body that can simply be rested.

            Bunions are a common problem among dancers who use turned-out positions and perform multiple relevés. 

Although they can be hereditary, bunions can also be caused when abnormal pressure is placed upon the inside of the foot at the base of the big toe.  Pressure is placed on this joint when a dancer wears a pointe shoe with a box that is too narrow, or when a dancer’s foot rolls inward, or pronates.  Forcingturnout can be a culprit, as can weak foot muscles that are unable to hold up the arch of the foot, and muscular imbalances.  Tight outward rotators, which are common among ballet and Irish step dancers, may cause a dancer to walk with his or her feet pointed outward.  Walking in this manner causes the dancer to push off the inside of the foot while walking and causes trauma to the joint.

            The body’s response to this trauma and increased pressure is to protect the joint.  Throughout our body, fluid-filled sacs called bursae can be found between muscles and tendons and joints to reduce any friction that might occur during movement.  The bursa sac that is found at the base of the big toe, or metatarsal joint, becomes irritated and inflames to provide increased cushioning.  At the same time, since bones respond to stress by increasing bony layers for protection, excess bone tissue develops on the medial side of the foot at the metatarsal joint.  The bursal inflammation causes the joint to become red, swollen, and painful.  The increased bone tissue causes a deformity of the foot known as hallux valgus.  Hallux refers to the big toe, and valgus simply means that a part of the body is at an abnormal angle.  In hallux valgus, the metatarsal joint is enlarged, forming a bony protrusion or bump on the medial side of the foot, and the big toe begins to angle in toward the second toe.

            In addition to being painful, hallux valgus disrupts the normal pathways of tendons and, therefore, prevents them from working correctly.  Hallux valgus also causes body weight to be redistributed in a strange way.

            In order to help relieve pain, dancers can soak their feet in warm Epsom salt baths that will have a soothing effect but should also use ice and ibuprofen to decrease the inflammation.  If the shoes are the culprit, narrow boxed shoes should be replaced with wider ones.  Toe separators and taping can provide immediate relief, but a physical therapist, who specializes in dance medicine, can help determine the cause and provide hip, ankle, and/or foot strengthening exercises to keep the bunion from becoming worse.

            In extreme cases, surgery may be necessary in which a doctor will scrape the excess bone tissue away and realign the first metatarsal joint.

            It is best for a dancer to pay attention to his or her feet and take action as soon as a bunion begins to develop.  Once the cause is found, steps can be taken to reduce the pressure on the metatarsal joint, and, hopefully, solve the problem before it becomes extremely painful or debilitating.