Everything you need to know about running and bunions
Bony lumps on the side on the feet known as bunions can be an awkward ailment for runners to manage. Not only do they make shoe fitting a nightmare but they can be very painful and are difficult to treat.
The condition, which is more common in older women, can also be found in athletes as a result of overload and trauma. The weight bearing forces through the first metatarsophalangeal joints (joints in the big toe) when running can make the joint more susceptible to trauma, potentially leading to bunion deformity, according to a paper in the journal Sports Injuries of the Foot. This can decrease performance and potentially prevent someone from running.
But there are ways to manage the pain, as well as a range of treatment options, so you don’t have to hang up your running shoes prematurely...
What is a bunion?
The simplest way to describe a bunion is a bumpy deformity on the side of the foot. The bony projection develops slowly on the joint at the base of the big toe and, as it gradually grows, your toe turns inwards over time. It can be found on just one or both feet.
The bunion itself is a jelly-like bursa sac that develops over the first metatarsophalangeal (MTP) joint as a result of a hallux valgus deformity of this joint. Hallux valgus refers to the lateral deviation of the big toe, where it moves sideways towards the second toe. Hallux valgus is found in at least 2% of children aged nine to 10 years and almost half of adults, with greater prevalence in women.
What are the symptoms of bunions?
Bunions are usually easy to spot as the main symptom is a hard lump on the side of your foot, near the big toe. This can cause pain and stiffness in the big toe joint. There may also be swelling, meaning the foot becomes wide and can be difficult to fit into a shoe. The skin over the bunion may be hard and look red or darker than the skin around it.
A bunion may also cause pain along the side of the bottom of the feet which is usually worse when wearing shoes and while walking or running.
What is a tailor’s bunion?
Also known as bunionettes, tailor’s bunions are smaller than regular bunions and occur on the outside on the little toe. They got their name from clothing tailors because the way they sat was believed to cause a misalignment of the bones in their small toe. A tailor’s bunion develops when the fifth metatarsal bone, at the bottom of the little toe, shifts outwards.
How are bunions caused?
The exact cause of bunions is not known but they are more common in people who wear shoes that do not fit properly. Although footwear may contribute to the deformity, studies comparing people who wear shoes with those who do not have found contradictory results.
Foot health specialist Bente Smith-Rewse, founder of Enertor, says genetics play a role as bunions often run in families. But she says it is also do to with foot structure.
‘If you are flat footed or have low arches you could be prone to developing bunions. When you are flat footed, your foot moves into the middle and overpronates, and that puts extra pressure on the big toe,’ she explains.
Wearing tight and narrow footwear, such as pointed shoes or high heels, will also force pressure into the joint which could create bunion formation.
A foot injury such as a broken big toe can also increase the risk of developing bunions, as can excessive weight.
Do bunions cause pain?
Unfortunately bunions can be very painful, particularly while they are still growing and the joint can still move. Once they are fully formed and become rigid the pain tends to subside. The pain is caused by pressure and frictional force exerted on the skin, soft tissue and bursa at the medial prominence of the joint. Bunions form slowly, often over many years.
What is the best treatment for bunions?
Prevention is the best approach because once a bunion starts forming its development can only be slowed, rather than stopped. This is where footwear is vitally important. Make sure your shoes are the correct size and have enough width for your toes.
And even if you already have a bunion, choosing the right running shoes will help with comfort and slowing its growth. Coach and Olympic runner Viktoriya Tkachuk, who won 400m hurdles silver medal at 2022 European Athletics Championships, says she always prioritises running shoes with a wide toe box, to help her clients manage bunions.
‘This allows ample room for toes to move freely without putting excessive pressure on the bunion. With a wider toe box, you can distribute weight more evenly across the foot, reducing the strain on the bunion. I avoid shoes with narrow or pointed toes because they compress the toes together and increase pressure on the bunion area,’ she says.
Tkachuk recommends the following running shoes for bunions:
Altra Provision – This is a great choice if you’re looking for a lightweight shoe that offers stability and allows you to run in a natural way. It sports Altra’s popular EGO midsole that brings with it lightweight cushioning for explosive takeoffs and soft landings.
Hoka Alahi 7 – The Hoka Alahi 7 is a favourite for runners with wider feet, and those that need support for overpronation. Its J-Frame technology guides your foot while its foam midsole offers a cushioned and responsive ride.
Glycerin GTS 21 – Featuring a 10mm heel drop, this is one of Brooks' plushest models. Its DNA Loft foam coupled with an ortholite sock liner offers step-in comfort and super soft cushioning.
Addressing your running gait if you overpronate is another important measure to consider. ‘Changing the way you are running to alleviate excess pressure on the big toe will slow development down,’ says Smith-Rewse.
Should I consider bunion surgery?
If you have exhausted all options then bunion surgery may be a possibility. However this should be a last resort as the results are mixed, and post-surgery can be debilitating and painful. An operation is performed under general anesthetic to scrape away the bunion and straighten the toe bone with metal screws. You will then need to avoid driving for at least six weeks and may not be able to run for three to six months.
The operation may cause toes to be weaker, stiffer or more painful than before and bunions can come back after surgery.
How can I shrink a bunion naturally?
It is not possible to shrink a bunion naturally but you can slow its progression and manage the pain. It can be helpful to do exercises to strengthen the muscles in the foot to manage the condition.
Smith-Rewse recommends exercises similar to treating plantar fasciitis such as scrunching up a towel with your toes and trying to pick up a pen with your foot. Tkachuk also says stretching and strengthening exercises for the feet and calves are essential components of bunion management for runners.
‘Once I integrate these exercises into my client's routine regularly, it significantly improves flexibility and reduces strain on the bunion,' says Tkachuk. Stretching exercises are handy to increase flexibility in the muscles and tendons surrounding the bunion. This reduces tension and promotes proper foot alignment,’ she says.
Can I run with a bunion?
It is possible to run with a bunion but the pressure of motion may make the pain worse. Bunion pads, taping and epitact buinion correctors can all help alleviate pressure, and pain, but will not prevent a bunion from forming or growing.
‘I’ve noticed placing cushioning pads around the bunion is magical in alleviating pressure on the affected area, which reduces pain and irritation during running,’ says Tkachuk.
Orthotic inserts can also offer customised support to the arch of the foot, promoting proper alignment and redistributing pressure away from the bunion. Again, there is no evidence that orthotics will prevent bunion progression but they may provide short-term pain relief.
Should I seek medical help for bunions?
It is important to seek medical help early to put steps in place to slow the growth of a bunion. A clear diagnosis will also rule out other foot conditions or injuries, such as gout, arthritis or a broken toe.
‘If you are in pain or have a slight formation of a bunion, see a professional like a podiatrist or a physiotherapist. You can then have a custom made insole made from a regulated clinician which can help to reduce the pain,’ says Smith-Rewse.
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