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Injuries and Medical Advice

Bunions

Bunion operations have progressed greatly in the last 20 years. What used to be basic carpentry is now more about engineering, and can produce both an aesthetically pleasing and functional outcome.

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Rock shoes can cause serious foot problems, including painful bunions. Illustration by Steve Graepel.
Rock shoes can cause serious foot problems, including painful bunions. Illustration by Steve Graepel.

I am developing a bunion on my right foot and it is increasingly painful to climb. I worry that my moderately aggressive climbing shoes have worsened the problem, as the toe-box pushes the big toe toward the middle of the foot. I basically can’t edge on my right foot at all, and it now hurts to run/walk more than a mile.If I have surgery, will I ever be able to edge, fully weight my foot, or smear?Is there a shoe you can recommend to use in the meantime?

—Kat, via rockandice.com

Ah, the old hallux abducto valgus deformity. The lump, which is mostly formed when the head of the first metatarsal tilts sideways,
is usually painful and becomes increasingly difficult to accommodate even in generous footwear, let alone a climbing shoe.

There is a general consensus that bunions are caused by footwear. The more the shoes mess with your toes, the more likely you are to develop a bunion.
There is also a bunch of research that suggests you can’t get a bunion unless you are genetically predisposed, even if you wear ridiculous high heels.

Don’t get me wrong about high heels. I love it when Hottie wears stilettos, but I would never expect her to walk in them—that would just be silly.

[Also Read The Curse of Lumpy: Dupuytren’s Disease]

There is nothing in the conservative-management paradigm that will help you don a climbing shoe short of cutting a hole to allow your bony bulge some pressure
relief. Opioid-strength painkillers could add some fun to your day but, like all drugs, long-term use will cause you more suffering.

Bunion operations have progressed greatly in the last 20 years. What used to be basic carpentry is now more about engineering, and can produce both an
aesthetically pleasing and functional outcome.

Not only will you climb again but you will be able to use your inside edge! There are a few caveats, however. Climbing shoes, like your red stilettos,
will not be recommended footwear, so do your best to be reasonable. Fit them a little bit less for performance and more for comfort. Think of it this way, loose shoes are better than no shoes. Horribly uncomfortable may get you up that polished granite slab, but it will also garner the wrath of your surgeon when you sit back down in her office 10 years from now.

[Also Read Beyond Tape: Bicep Tendonitis]

Choose an asymmetrical shoe that minimizes sideways push on the big toe. A good rule of thumb is that if you can put them on with socks, not only will
you look French, your toes will have some breathing space.

At all other times wear comfortable shoes (or no shoes). If your toes can rattle, the fit is perfect.


This article appeared in Rock and Ice No. 219 (July 2014).