Run Without Pain: How to Reduce Bunion Pain and Enjoy Your Marathon Training

As we lace up our shoes and hit the pavement in preparation for the fall half marathon and marathon season, foot and toe problems can throw a wrench in our training plans.  In a previous article, I wrote about plantar fascia and how it sidelines many long distance runners during midseason training.  Today, let’s talk about bunions- These little bony bumps at the base of the big toe can cause a lot of pain and discomfort, making it tough to stick to our training schedules.

But here's the good news: bunions aren't just a genetic curse. They often develop due to factors like our footwear choices, hip and pelvis mobility, and even our running form. By addressing these issues early on, we can reduce the chance of bunions developing before they start or at least slow their progression. Let's dive into how we can keep our feet happy and healthy for marathon season!

Understanding Bunions

First things first, what exactly are bunions? Medically known as hallux valgus, bunions are bony bumps that form on the joint at the base of your big toe. They develop when the big toe pushes against the next toe, causing the joint to stick out and become enlarged. While genetics can play a role in their development, bunions are often not the root cause of foot pain. Instead, they are a symptom of underlying issues such as improper footwear, inadequate hip and pelvis mobility, and poor running form.

So, while you might have your parents to thank for your eye color or height, bunions aren't necessarily something you have to blame on genetics. Let's take a closer look at the real culprits behind bunions and how we can address them.

 The Real Culprits: Footwear, Hip Mobility, and Running Form

Footwear Choices

One of the biggest contributors to bunion development is the type of shoes we wear. Tight, narrow shoes and high heels can exacerbate bunion development by forcing the toes into unnatural positions. Runners, especially those preparing for long distances, need to pay extra attention to their footwear. Here are some tips for choosing the right shoes:

• Wide Toe Box: Look for shoes with a wide toe box that allows your toes to spread out naturally. This reduces the pressure on the big toe joint.
• Appropriate Arch Support: While I’m not a fan of long term orthotic use, for some people, having the right arch support can help maintain the alignment of your feet and reduce stress on the big toe at least in the short term.
• Avoid High Heels: Save the high heels for special occasions and stick to supportive, comfortable shoes for everyday wear.

Hip and Pelvis Mobility

Limited mobility in the hips and pelvis can lead to compensatory patterns in your feet, contributing to bunion formation. Ensuring proper alignment and flexibility in these areas is crucial. Here are some exercises to improve hip and pelvis mobility:

• Hip Flexor Stretches: Stretching the hip flexors can help improve overall hip mobility. Try the lunge stretch, holding for 30 seconds on each side.
• Glute band side steps: Strengthening the glutes can improve hip stability. Perform 3 sets of 5-8 reps, 3-4 times per week.
• Hip Rotations: Improve hip mobility by performing seated hip rotations. Sit on the floor with your legs bent, and slowly rotate your hips in and out.

Running Form

Poor running form, such as overpronation (where the foot rolls inward excessively), can place undue stress on the big toe joint. A running analysis can help identify and correct these issues, reducing the risk of bunions. Here's what to focus on:

• Cadence: Aim for a higher cadence (steps per minute) to reduce impact forces on the feet. A good target is around 170-180 steps per minute.
• Foot Strike: while I prefer a mid or forefoot strike for my running gait, not everyone can run with this landing pattern.  Regardless of foot strike preference, the key is to land softly. 
• Posture: Maintain an upright posture with a slight forward lean from the ankles. Avoid slouching or leaning too far forward.
• Arm Swing: Keep your arms at a 90-degree angle and swing them forward and back (not across the body) to maintain balance and efficiency.

 Interventions and Exercises

Addressing bunion formation involves a combination of targeted exercises, manual therapy, and possibly more advanced treatments like shockwave therapy and dry needling. Here’s a detailed look at effective interventions:

Exercises for Foot Strength and Flexibility

1. Heel Raises

• How to Do It: Stand with your feet hip-width apart. Slowly rise onto your toes, then lower back down.
• Reps and Sets: 3 sets of 15-20 reps, 3-4 times per week.
• Benefits: Strengthens the calf muscles and supports the arch of the foot. Strong calves can help reduce the load on the big toe joint.

2. Side Steps with Resistance Bands

• How to Do It: Place a resistance band around your ankles. Step sideways, maintaining tension in the band.
• Reps and Sets: 3 sets of 15 steps each direction, 3-4 times per week.
• Benefits: Strengthens the hip abductors, which can improve overall leg alignment and reduce stress on the feet.

3. Toe Spreads Using Yoga Toes or Toe Band

• How to Do It: Use yoga toes or toe bands to spread your toes apart and hold for 10-15 minutes.
• Frequency: Daily.
• Benefits: Improves toe alignment and flexibility, reducing bunion pressure. This simple exercise can make a big difference in preventing bunions.

4. Toe Curls

• How to Do It: Place a small towel on the floor and use your toes to scrunch it up.
• Reps and Sets: 3 sets of 10 reps, 3-4 times per week.
• Benefits: Strengthens the intrinsic muscles of the foot, improving overall foot mechanics.

5. Arch Lifts

• How to Do It: Stand with your feet flat on the floor. Slowly lift the arches of your feet while keeping your toes and heels on the ground. Think (“shorten the foot” or “raise the arch). 
• Reps and Sets: 3 sets of 10 reps, 3-4 times per week.
• Benefits: Strengthens the muscles that support the arch, reducing stress on the big toe joint.

 Manual Therapy and Advanced Treatments

1. Manual Therapy of the Big Toe

• How to Do It: Seek a physical therapist who can perform joint mobilizations and soft tissue work on the big toe.
• Benefits: Increases mobility and reduces pain in the big toe joint. Manual therapy can help realign the joint and improve overall foot function.
  

2. Shockwave Therapy

• Benefits: Promotes healing by stimulating blood flow and reducing inflammation. Shockwave therapy is particularly useful for chronic pain and stiffness associated with bunions. It can also help break down scar tissue and improve tissue regeneration.

3. Dry Needling

• Benefits: Targets tight muscles and fascia, releasing tension and improving overall foot mechanics. Dry needling can provide relief from pain and improve mobility by addressing trigger points and muscle imbalances.

4. Toe Joint Mobilization 

• How to Do It: Regular foot massages can help improve circulation, reduce muscle tension, and promote relaxation.
• Benefits: Enhances overall foot health and can help prevent the development of bunions.

 Exercises for Hip and Pelvis

1. Hooklying Breathing

• How to Do It: Lie on your back with your knees bent and feet flat on the floor. Focus on deep diaphragmatic breathing.
• Reps and Sets: 5-10 minutes daily.
• Benefits: Enhances pelvic alignment and core stability. Proper breathing techniques can also reduce stress and improve overall performance.

2. Front Foot Elevated Split Squats

• How to Do It: Place your front foot on a raised surface. Lower into a squat, keeping your torso upright.
• Reps and Sets: 3 sets of 10-12 reps per leg, 2-3 times per week.
• Benefits: Strengthens the quads and glutes, improving hip stability. This exercise can also help correct muscle imbalances and improve overall lower body strength.

3. Slant Board Squats

• How to Do It: Stand on a slant board with your feet hip-width apart. Perform squats while maintaining an upright posture.
• Reps and Sets: 3 sets of 10-15 reps, 2-3 times per week.
• Benefits: Enhances hip and ankle mobility, reducing compensatory foot mechanics. This exercise can also improve balance and coordination.

4. Hip Abductor Strengthening

• How to Do It: Use a resistance band around your thighs and perform side leg lifts.
• Reps and Sets: 3 sets of 15 reps per leg, 3-4 times per week.
• Benefits: Strengthens the hip abductors, improving overall hip stability and reducing stress on the feet.

5. Pelvic Tilts

• How to Do It: Lie on your back with your knees bent. Slowly tilt your pelvis forward and backward.
• Reps and Sets: 3 sets of 15 reps, 3-4 times per week.
• Benefits: Improves pelvic mobility and alignment. This exercise can also help reduce lower back pain and improve overall posture.

The Importance of Alignment: Maintaining the Stack

"Stack" refers to the alignment of the pelvis, hips, and trunk when standing. Proper alignment reduces the risk of compensatory movements that can lead to bunion formation. Focus on maintaining a neutral pelvis, avoiding excessive anterior or posterior tilt, and ensuring your hips are level. Here are some tips for maintaining proper alignment:

• Stand Tall: Keep your shoulders back and your chest lifted.
• Engage Your Core: Maintain a slight tension in your abdominal muscles to support your spine.
• Distribute Your Weight: Evenly distribute your weight across both feet to avoid placing too much pressure on one side.
• Check Your Posture: Regularly check your posture throughout the day to ensure you are maintaining proper alignment.

 Running Analysis: Identifying the Root Cause

A professional running analysis can pinpoint biomechanical issues contributing to bunions. By evaluating your running gait, hip and pelvis mobility, and footwear, a physical therapist can develop a personalized plan to address these issues. Here’s what a running analysis typically includes:

• Gait Analysis: Assessing your running form to identify any biomechanical issues that may contribute to bunions.
• Footwear Evaluation: Ensuring your shoes provide adequate support and fit properly.
• Strength and Flexibility Assessment: Evaluating the strength and flexibility of your hips, pelvis, and feet to identify any imbalances or weaknesses.
• Movement Analysis: Observing your overall movement patterns to identify any compensatory movements that may contribute to bunion formation.

At Next Level Physio, we offer a comprehensive Runner's Foot Analysis, including a bunion and plantar fascia assessment, running gait analysis, and footwear evaluation. With over 25 years of experience and thousands of runners helped, we are dedicated to getting you back to what you love. Book your assessment today and take the first step towards bunion-free running!