Bunions
 

I've suffered from foot pain on the bike for years, and it gets worse each year. I finally have a diagnosis I believe, which is bunions. I'm 55 years old. Surgery seems like a viable option, but before I go under the knife, I'll learn about how helpful various therapies might be. The podiatrist said that untreated, it will definitely get worse, and the best path to reducing suffering is to reduce my activity level. My pain has reduced my activity level, and my hope is to increase it somehow, not reduce it.

If you have or had bunions, I'd like to hear how you have dealt with them.

Walking isn't bad for me except after I ride. Riding is bad. It gets bad before an hour is over most of the time. I'm wary of riding for longer periods. But I wish to take multi-hour rides.

IMO most foot problems are caused by bad shoes. The primary problem is that most people cant find shoes that are wide enough for their foot. This is especially true of cycling shoes.

I had surgery for Hallux Valgus(aka "bunion") about 10 years ago. I sought treatment when I reached the point it took 24hrs before I could walk normally after a 10K run.:mad:

The surgery was a piece of cake. The recovery is what is annoying as hell. I had to spend a month flat on my back. The issue is that the hydraulic head pressure of my 6'1' frame would cause the foot to swell in *minutes*. I am not kidding, standing up causes the foot to start swelling like a football in just minutes, then it takes days to go back down. The biggest aggravation was the Dr wanted me to come in for an office visit every week, and the time spent sitting in the car, and the office, was the worst thing I could do it. If I had to do it over, I would just refuse an office visit for the first month.

I have a friend with the worst case I've ever seen; His big toe is bent toward the others at a 45-degree angle, and he still has had nothing done for it.

Bingo. I had suspected shoes were the cause, even though my surgeon would not say it. The more I've read, the more I am convinced. I have even read articles that stated in cultures where barefoot, or open-toed sandals are the norm, the problem is never seen.

Thanks. It seems like I'll need to take a medical leave. I work at a college, so thank god it's a good place to work for things like this.

And yes, for most of my life, I bought ill fitting shoes because I didn't know. Only too late did I discover I should be buying shoes a size "too large" so I have the width I need. My daughter discovered that for herself soon enough, so good for her. (She's 27.)

Sorry to hear that Tom. For me, those early Campy road pedals which seem to have been designed for small feet didn't help me make the right shoe choice. Both my bikes from the 70's and 80's had 'em and I was always trying to find cycling shoes narrow enough to fit those nice-but-damn things.

My foot surgery was not "one and done". But YMMV since your symptoms sound different from mine. Now (after two surgeries on my bad foot), I can usually walk just fine after a long ride as long as I wear shoes that don't flex. I like to say that I roll better than I can walk, any day - but more surgery is in my future. What I find is that if I pay attention to wearing the right thickness of cushion socks, combined with the right size rigid shoe (tied carefully so not too tight), I have little enough pain so that I can do my daily 10 mile commute and still be able to walk the dog on some days. Some days, not so much.

I had my first Hallux Valgus operation at your age, 11 years ago - my great toe was crossed under the second, and my great metatarsal joint caused me lots of pain. I spent three weeks with my foot elevated over my heart, so yes, short term disability comes into play if available. Everything Shimagnolo says about hydrostatic pressure is true. Put your foot down and you'll know it right away. When the wound site swells the sutures can open up, delaying healing significantly. On the other hand, they really want to monitor the wound site to assure that no sepsis can arise. The longer you can remain with your leg maximally elevated in the first weeks, the better.

I had to have the operation done again four years later on the same foot (or is it three - I repress remembering unpleasant things!). The first doctor failed to "release the capsule" of the joint. I had similar healing period, with leg elevated, another time off work, and another prolonged recovery period.

And today, I'm in sufficient pain when walking that I've been advised by the best foot doc in this burg that the next step is surgery to fuse the two adjacent metatarsals with a plate, after doing much chisel reduction of the malformed joint. Meanwhile, my podiatrist said that in previous decades, sufferers would be sent to a shoemaker to fashion shoes with steel shank rigid soles. I found some really comfortable Shimano MTB shoes which will fit cleats but without cleats are totally walkable - and I've worn them constantly on a daily basis at work ( I stand all day) for the last 18 months. My foot simply won't tolerate flexing at the metatarsals. But I'm totally off the idea of spending another month or two on my back - at 66, you lose a lot of muscle tone in that time. So I'm postponing further surgery until I simply can't take the pain. But this is complicated for me because I also have a knee that is completely devoid of lateral cartilage and hobbles me sometimes too. Multiple surgeries on that leg are in my future - one for knee, one for my third round on the foot. Sigh.

We take walking completely for granted. It is hard to say at this stage whether any surgical fix for you will be permanent. I think the best approach is to learn as much as you can before committing to surgery. Look up Hallux Valgus on Medscape and other websites. It's scary and informative at the same time - and the terminology may be foreign, but there are a lot of options which are determined by your specific joint deformity. It is vital to ask your orthopod what s/he feels about the outcome of the proposed surgery, or how long they think the fix would last. That way you'll be less disappointed if it turns out like mine did - it is good to be psychologically prepared. If you can approach the surgeon having learned about the different procedures and options, you're in a better position to ask questions rather than let the surgeon take the lead. Also, if you're in a position to have an independent second opinion by another recommended surgeon, you might find that they recommend a different surgical procedure than the first. Fortunately you are in an area dense with orthopedic surgeons, so it might be easier for you to find a short list of "best surgeons" for your problem. Ultimately, your stated goal to your surgeon should be that you want the procedure which gives you the highest chance of pain free outcome without having to have further surgery in the mid term future. If you do your homework before hand, it is certain that you will be a better advocate for yourself. After all, the surgeon won't have to do the walking for you a decade from now.

Anyway, good luck with whatever you chose to do.

I arrested my thought I was gonna need surgery, left foot bunion problem/issue with the help of my podiatrist through stop doing that bad habit/better shoes/orthodics. That was four or five years ago and no further progression nor limitations on normal activity. YMMV, of course, but I'd look into alternatives and get a second opinion before cutting. It's a seriously not fun surgical procedure.

Thank you [MENTION=67800]CrankyFranky[/MENTION]. I will be very careful before proceeding. The weird thing is that I have less pain when cycling with more flexible shoes, which is not what most experienced cyclists prefer. I've had plenty of very stiff cycling shoes, and they encourage me to keep my feet still. I've learned that wiggling my toes around is good for me. And I learned long ago that quill pedals are a total deal breaker. I could never use them.

And [MENTION=165582]itx[/MENTION]i, thank you, too.

Given that you don't have issues walking, it doesn't sound so bad. My first crap shoot guess is that your bike shoes may be the root cause, or at least a major contributing factor.

You can test that theory easy enough by riding on classic pedals with or without toe clips. Wear loose (wide) shoes, and maybe try a wad of cotton between the big toe and the next to help keep it from getting pushed inward. You might also try some padding behind the bunion to prevent direct pressure there. If it turns out that riding is possible with the right shoe, or at least a glimmer that it might work, see a foot man for a referral to someone who can build inserts for your cycling shoe, though you might have to buy larger, or wider shoes to accommodate it.

Years ago, when shoes were made of leather, those of us with foot issues used to put on the shoes and stand in a bucket of hot water, then sit in the sun with our feet up, while our "custom made" shoes dried to form. Unfortunately modern cycling shoes are made of rigid fabrics, and there's no way to mold them for comfort.

I suspect that this can be made manageable or gone without surgery, if you're patient and a decent detective.

Thank you, [MENTION=158672]FBinNY[/MENTION]. I've tried all kinds of cleat positions, saddle heights, saddle fore/aft positions, handlebar positions, and cleat less pedals. I might find better positions, but that avoids the problem but doesn't undo the damage, and there is definitely damage. I am going to see someone whose specialty is called Hanna Somatics, and maybe I'll also see a physiatrist. I agree that avoiding surgery may be possible. The podiatrist said corrective devices such as orthotics won't help me, but I know that advice might be wrong for me.

Had a buddy who had the surgery and he said that he wouldn't have it again if he had it to do over again. My brother also has issues and swears by getting shoes that are a larger size.

Tom, you missed the point of my post, which was that I suspect the shoes themselves, not the bike or position. The only reason I suggested standard pedals was so you could ride in wide comfortable shoes.

Bunions are usually not bothered by direct vertical pressure on the bottom of the foot, and yours don't seem to be either since you can walk OK. SO, I suspect the side pressure directly on the bunion or the deflection of the big toe from the shoes you are riding in.

BTW- if you still know an old time shoemaker, he might be able to help. Many of them have experience stretching shoes in critical areas to relieve pressure there.

So, don't fret over your position, and focus on shoe fit. If you have an old pair destined for the trash soon, consider cutting away the area where the bunion is and seeing if that makes a difference. If so, you know the direction where a solution lies, and the rest is the details.

Francis, if I had remembered to tell you about my shoe experimentation, you might see that I didn't miss your point. It's not shoes. I have worn all kinds of shoes. The shoes I wear the most have copious extra room, and it reduces pain but doesn't eliminate it. I have the same pain when riding barefoot, which I have tried but not done often. Perhaps the damage was done by the wrong shoes. In fact, it seems likely. But the damage is done, and it can't be undone with shoes, nor does my choice of shoes affect the pain I now experience.

I have no foot problems what so ever, I think for two reasons. I buy mail order shoes from Mason shoes, that have wide shoe sizes available. I wear EE. And I never wear shoes in the house.

Me too. I have duck-like feet, and went with wide cycling shoes from the start (initially, that included only Lake and Sidi so far as I know), and wear sandals or flip-flops otherwise. I still get Morton's Neuroma on occasion.

Stupid question, but has the OP tried custom orthotics? They can work wonders.

This guy seems to disagree with the "damage is done:" https://nwfootankle.com/about/1

Two years ago (and about 6 months after I became cycling junkie), I developed a super painful bunion on my right foot. I first noticed the pain while cycling, then felt it while walking. It became excruciatingly panful. he podiatrist did x-rays and pushed surgery. I did some internet surgery and learned that the surgery results were mixed at best. I started treating it medically with toe pads, compound W to soften the corns, trimming off the dead skin.

Now I am pain free and cycling 150 miles a week--as long as I stick to the routine.

Oh yeah, wide toe shoes were a big help, too.

[MENTION=158925]takenreasy[/MENTION] and [MENTION=365243]raceboy[/MENTION], I was hoping to find information such as yours. Thank you. I will educate myself further and proceed cautiously.

Thanks for posting this, I just ordered the correct toes and will see if they help straighten my big toes. I read through the site, watched his videos and was convinced to give it a shot. Expensive but cheaper than a set of new tires, eh? That surgery sounds like a real sob so worth a try to avoid the knife.

This was a very timely thread; amazing what I learn on BF.

Even though it may not seem like I'm heeding it, your advice is helpful, [MENTION=158672]FBinNY[/MENTION], so thank you.

Yeah the problem is modern shoes aren't foot shaped. But our society is more concerned about what looks nice or cool or whatever. If you look at traditionally unshod societies their toes splay out, fan shaped. 99.9% of modern shoes will have the area by the big toe curving inward, where it shouldn't, and over time this causes the toe to develop crooked. Same with pinky toe on the other end. Almost everyone's feet in modern societies are somewhat deformed simply due to wearing common shoes, thanks Nike! Mine aren't so bad since I always went a size up or more, so my toes weren't crammed into the narrower tip of most shoes. But still a slight curve in on each end and all my toes are more or less touching. I stopped wearing normal shoes back in 2011. For the most part I've been barefoot. Bare feet are healthy & happy feet, just pay attention to where your stepping. Sorry noglider I know this doesn't help you much now... and I've never had bunions so not much advice there except wish you a speedy recovery.

Look into Keen's, Birkenstocks, and some versions of Doc Marten's. (I'm sure there are other brands with "oblique" toes. Meanwhile, you can get silicon toe spacers that will counter some of the inward pressure. Some of them also have a sheet of thin silicon that covers the side of the foot. Long ago, I injured my right foot doing martial arts, and it has started developing a bunion. My podiatrist says that if people went barefoot more, there would be no bunions. It's hard to do barefoot in the desert. These days, I mostly wear the separate toe shoes, like barefoot running shoes. DON'T wear them if you actually run and are a heel striker--- you'll develop other problems. They do work for me walking in sand, etc, with some protection from rocks, briars, etc.

got pics? x-rays? I'm interested cuz my doc likes to call the deformity of my big toes, bunions, but the podiatrist examining the x-rays says the swelling is soft tissue caused by my ongoing gout. my primary doc says "oh yeah those terms are interchangeable" but they are not.

http://www.differencebetween.net/sci...ut-and-bunion/

good luck with the surgery, jealous of your work situation!

in this pic ignore the red box, but see the yellow circle

[MENTION=134410]rumrunn6[/MENTION], I don't have x-rays. I'll ask the podiatrist, especially since I want to bring them to other doctors.

Your primary doctor is dead wrong. I'm rather shocked that he would get that wrong, because it seems easy for even me to understand, but I guess no one can know everything. I'm a (computer) system administrator, and people are surprised that I don't know about ERP software or internet marketing, because those are related to computers, but they are all sub-specialties.

My x-rays look like the bunion x-ray in the page you cited. Looking at my foot, the problem looks to be mild. Yesterday, I did a lot of fast walking while carrying lots of heavy stuff, and in the middle of that, I stood for a couple of hours while singing in a concert. My feet (and the rest of my body) hurt a lot.
[MENTION=407088]Needles[/MENTION], I am trying the toe spacers that go between the big toe and the next one. No opinion yet on whether they are good, bad, or indifferent for me. The podiatrist said they won't help, but I figure trying them for a few weeks can't hurt. The suggestion of toe shoes is intriguing. I don't jog, so I should be good. But with those, I don't think I can wear toe spacers.

If I can't wear those weird toe shoes, I think I better go shoe shopping and replace all of my shoes. I discovered about five years ago that I was buying shoes too small. The foot size measuring machine in the shoe store says I'm a size 11. I started wearing size 12 shoes, and that has been better. Now I think I should probably be buying size 13. My feet's widest points are farther forward than normal feet, even though they aren't unusually wide. That has been my problem all my life.

There is a facebook group called Social Cycling NYC, and I asked the folks there for a sports doctor recommendation for someone who knows cycling. A member whom I know and trust says he works with a podiatrist who knows cycling, so that sounds like a perfect next step. Not only that, he's very close to where I work!

sounds good

wish there was a planet with less gravity we could visit for rehab

it takes years and even decades of abuse in the form of tight, ill fitting or poorly designed shoes to develop bunions. Then, after that long slow process we reach a tipping point where they interfere with our mobility. Now, we expect to reverse the effects of a decade long process in a few weeks.

Realistically, you have to be more patient with your body, and find ways to manage the problem and avoid flare ups, hopefully to get back to the other side of that tipping point. Then by no longer adding to the problem, you have hope of it slowly resolving itself, which in most cases it will.

Wide, roomy shoes, and some support to maintain toe alignment, and some time for the inflammation to ease, and you might get the problem back to where it was less of one.

Summer's coming, consider wearing sandals of the type held on between the big toe and it's neighbor as much as possible (even to work, with an explanation) until September, and your foot might have a chance to fix itself.

Thank you, Francis. It makes sense. I have to urge my daughters (in their 20s) to listen to all medical advice (within reason). I didn't listen, because I didn't understand its importance. It seems that my tolerance for low grade pain is much too high. There were signs, but I didn't feel them, but when I look with retrospect, I see that they were there.

I'm sorry to read this, Tom.

I wonder if you might end up getting custom cycling shoes?

And there are sandals with cleats . . .

Thank you, [MENTION=63590]jyl[/MENTION]. At this point, it's beyond just needing better shoes. When I wake up in the morning and walk to the bathroom, my left foot hurts from walking barefoot. I've tried sandals, and I've even tried pedaling barefoot. Shoes can't undo the damage to my feet.