Athletic Shoe Guidelines

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes . The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Varus. Bunions can also lead to other toe deformities, such as hammertoe.

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult--all contributing to chronic pain.

Bunions have been with mankind since the beginning of time. Undoubtedly they have received more attention since shoes have become a vital part of our fashion. It is generally recognized that those who have a bunion deformity most probably inherited the tendency from an earlier generation. So often people are told "don't have anything done until you can't stand the pain"! This is a misconception! Our rule of thumb is that when it becomes obvious that you have a bunion, that is the time to correct it!

Treatment for Bunions

Certainly the goal in bunion treatment is to limit the deformity and to stop the progression if it has already begun. This can only be done in the very beginning stages. When it is seen that the deformity is beginning in children and young adults, often the use of a good custom orthotic will stop the progression of the deformity. Also wearing shoes that do not irritate the deformity is also wise.

Surgical Treatment

The greatest hurdle that people with bunion deformities have to overcome is history. In most instances, these people have had a relative with the same deformity who years ago had surgery and they remember the pain and the weeks and months in casts and on crutches. They also remember that after going through all of this pain and suffering, in many instances the bunion came back.

The good news is that in the past 10 years new techniques and better instrumentation have been developed. Bunion correction of today involves the use of micro instruments with precise cuts in the bone to correct the deformity, thus limiting the rate of re-occurrence. The old days of the doctor saying "I'm going to have to break the bone and reset" it are gone. If anyone says that to you, run as fast as you can! Gone are the days of casts and crutches and wheel chairs post-operatively. Only in the most severe cases must the patient be "non-weight bearing". In most cases, the patients at the Ford Center can resume a fairly normal lifestyle in days or weeks rather than months.

At the Ford Center for Foot Surgery, the procedures are done with I.V. sedation administered by one of our qualified anesthesiologists. We also use a regional anesthetic which is much safer than a general anesthetic. We can do this because we do not use tournequets when we do foot surgery. This minimizes post operative pain as well as the risk of blood clots. The net result of this is that the patient is awake and can walk within minutes following the surgery but their foot is numb for 18 - 20 hours.

The procedure itself is accomplished through an incision on the inside of the foot, thus there are no unsightly scars. The capsule of the joint is exposed and is opened revealing the "bump" on the side of the metatarsal bone. The over growth of bone is removed. Next a very precise "V" cut is made in the bone from one side to the other and the end or head of the bone is moved over. This narrows the foot back down to its normal width. To maintain this, a small screw is placed in the bone to secure the correction. The skin and soft tissues are then sutured and the foot bandaged. The foot is then placed in a post op shoe that will be worn for several weeks.

As a general rule, our patients return to comfortable shoes in 2 to 3 weeks.

Athletic footwear should be fitted to hold the foot in the position that's most natural to the movement involved. Athletic shoes protect your feet from stresses encountered in a given sport and to give the player more traction. The differences in design and variations in material, weight, lacing characteristics, and other factors among athletic shoes are meant to protect the areas of the feet that encounter the most stress.

Well-fitted athletic shoes need to be comfortable, yet well-constructed and appropriate for a given activity. A good fit will mitigate blisters and other skin irritations.

Sports-specific athletic shoes are a good investment for serious athletes, though perhaps a less critical consideration for non-athletes. Don't wear any sport or other shoes beyond their useful life.

A running shoe is built to take impact, while a tennis shoe is made to give relatively more support, and permit sudden stops and turns. Cross training shoes are fine for a general athletic shoe, such as for physical education classes or health club exercising, such as on stair machines and weight-lifting because they provide more lateral support and less flexibility than running shoes. They also tend to be heavier than running shoes, but most people don't need light, flexible shoes for cross-training. If a child is involved more heavily in any single sport, he or she should wear shoes specifically designed for that sport.

Our practice recommends sturdy, properly fitted athletic shoes of proper width with leather or canvas uppers, soles that are flexible (but only at the ball of the foot), cushioning, arch supports, and room for your toes. Try a well-cushioned sock for reinforcement, preferably one with acrylic fiber content so that some perspiration moisture is "wicked" away.

Athletic shoes need to be replaced after one year, whether or not they are worn, and after a certain amount of repetitive load is placed on them and wears them down. The American Academy of Podiatric Sports Medicine advises replacing running or walking shoes after 300 to 500 miles of wear, and replacing aerobic, basketball, and tennis shoes after 45 to 60 hours of wear. Athletic shoes should also be replaced if they show signs of unevenness when placed on a flat surface, display noticeable creasing, and/or when the heel counter breaks down.