BEATING BUNIONS IN PICKLEBALL.... Strategies To Play Despite Big Toe Deformities

What is a bunion anyway? 

A bunion is a joint deformity (an angulation or protuberance) commonly found at your big toe and your little toe which results in these toes pointing inward toward your other toes (see figure 1.1) These deformities can be mild or severe in angulation and can be painful or completely asymptomatic. Regardless, the development of a bunion is not as simple as the end of your toe bending inward, in fact, a big toe bunion can involve abnormal rotation of your long, big toe bone leading up to the middle of your foot and exposure of small bones (sesamoids) that are normally hidden under your big toe joint. Bunions in the advanced stages can only be “corrected” with surgical intervention, however, the progressive worsening of bunions can be thwarted if a strategy is implemented early! 

(Figure 1.1)

Do Big Toe Bunion Correctors Really Work?

Yes and No. There are several products and marketing claims that bunion correctors will fix your problem and this is misinformation or misleading at best. The structural changes that occur with bunions are not correctable by positioning the big toe in some brace or other straightening contraption. 

However, there are very specific “bunion correctors” (See figure 1.2) that can be worn with or without shoes and can serve to align your toe joint so that when you walk, you load through a better aligned joint. Walking through and pushing off of an aligned toe joint vs a deformed joint can reduce abnormal forces and loading in that joint. This can lead to pain reduction and perhaps the slowing down of joint degeneration.

(Figure 1.2)

Top Strategies To Care For Your Big Toe Bunions So You Can Function Better On and Off the Court

• Seek out an expert foot specialist so that the primary causes or contributing factors to your bunions can be identified, evaluated, and addressed in your overall strategy. I do not recommend Cortisone shots! You need a skilled strategy for your feet! 

  
  

  • Strategies and recommendations by a skilled foot specialist may include but are certainly not limited to:

    
    

    • Using a bunion corrector as seen in figure 1.2 for improved joint loading

      
      

    • Isometrics for specific big toe muscles

      
      

    • Very specific intrinsic (muscles that reside in the foot exclusively) and extrinsic (muscles that have attachments out of the foot but attach in the foot)  foot muscle strengthening exercises. (Not some run of the mill stretchy band exercises moving your foot in 4 directions)

      
      

    • Wide toe box but well fitted pickleball shoes

      
      

    • Extracorporeal Shockwave Therapy (Preferentially the Softwave brand) for big toe joints and perhaps for a joint a little further up your foot known as your 1^st Tarsometatarsal joint as well as surrounding soft tissues. This can help reduce pain significantly and help to heal tissues.

      
      

    • Strengthening and coordinated functional loading exercises involving your entire leg, knee, hip, pelvis, spine muscle groups.

      
      

• Avoid “One and Done” treatments like Cortisone shots as these “potentially” can give you some temporary relief, but they don’t fix the underlying issues and can actually lead to further degenerative changes in your tissues. 

  
  

• Wear toe spacers for the other toes too as the crowding effect that can occur with big toe bunions can actually lead to Morton’s Neuroma (see my article on Morton’s Neuroma at drpickledink.com in the web spaces between the smaller toes. 

  
  

• Limit narrow toed sneakers and shoes 

  
  

Final ThinkaDink

**These are all guidelines and strategies Dr PickleDink implements in his daily practice. It is ALWAYS important to seek a true foot specialist or even more than one who has the knowledge and experience to be able to implement the comprehensive strategies listed above, you deserve nothing less and you only get 2 feet for life so take the best care of them!

Sincerely,

Dr. PickleDink^TM