Bunions: Are They Preventable?
By Colleen Bickel, PT, DPT, COMT
Colleen will be leading our Lunch & Learn this Wednesday at DWC Renton at 12:30PM, click here to register!
Hallux valgus (commonly known as bunions) are a frequent site in a dance class.
Hallux: big toe
Valgus: oblique displacement away from centerline
Bunion: word likely originated from the early 18th century from ‘bunny’ or ‘boni’ to describe a swelling or from the Greek word for turnip
There is still a lot of research that needs to be done to understand this complex condition. We know that dancers are prone to bunions. But we also know this condition has a strong genetic component.
How common are bunions?
Age 18-65: about one-third of the population
Twice as common in females
Dancers: a recent study showed 89% of professional ballet dancers have bunions
Things that likely DO NOT contribute:
Number of hours dancing per week
Hours of pointe work each week
Total years of pointe work
Age of starting pointe
Intensity (professional versus recreational)
Things that likely DO contribute:
Genetics
Faulty technique patterns
Plantarflexion hypermobility (pointed foot position): the average person has 50 degrees while the average female professional ballet dancer has 113 degrees
Muscle imbalances around the great toe
Things WE DON’T KNOW if they contribute:
Tight shoes (flats, pointe shoes or street shoes)
The main faulty technique patterns:
Forcing turnout out, end-range exaggerated turnout with hyper-pronation compensations, increased turnout from the leg rather than the hip
Winging while en pointe
Why should we care:
It’s a progressive condition: while a younger dancer may not have any issues now, it’s best to learn ways to limit the progression so their older body will thank them
Can lead to arthritis and pain in the big toe with walking, relevés, pointing and jumping
Can contribute to poor balance and proprioception
What dance-specific manual physical therapists do:
Check for muscle imbalances between extrinsics/intrinsics (muscles that start in the calf and travel to the foot versus muscles just in the foot)
Check for muscle imbalances between medial/lateral calf (inner and outer calf)
Improve joint mechanics in foot (make sure all the bones/joints are moving well)
Release tight muscles pulling on the great toe & teach dancer how to do that
Teach individual strengthening exercises based on dancer’s weaknesses
Help dancer find toe stretchers and spacers (there are a lot of options out there)
Help dancer identify optimal street shoes
Help dancer identify poor mechanics: walking, pointing, turnout, relevés, jumping
So, are bunions preventable? If you do not have the genetic propensity, then potentially yes. If you have the genetic propensity, then maybe not. Either way, we can make a lot of changes to reduce the risk factors and the progression. Happy Dancing!
Colleen will be leading our Lunch & Learn this Wednesday at DWC Renton at 12:30PM, click below to learn more!
By Colleen Bickel
Colleen Bickel was born and raised in Albuquerque, NM. After obtaining a BFA in Modern Dance from the University of Utah, she was able to tour as a professional dancer for many years. Colleen traveled all over the United States before settling in the concrete jungle of NYC. Living the artist’s life in NYC was a dream come true, but after a while she realized she was longing to reconnect with mountains and nature. Colleen graduated with my Doctorate in Physical Therapy from the University of Washington and has called the gorgeous PNW home ever since.
Colleen's passion has always been to understand the inner mechanics of the body, whether for the everyday functions of life or for the more intense activities of the professional athlete or weekend warrior. She worked as a bookkeeper for many years (which helped pay the rent for her artistic life), and feels passionate about proper ergonomics and fitting physical activity into daily life. Colleen loves learning and is a certified Level 5 Romana’s Pilates Instructor and a MELT (Myofascial Energetic Lengthening Technique) Level 1 practitioner. She has taken classes in Ideokinesis, the Franklin method, Bartenieff Fundamentals, and other myofascial release systems. Additionally, Colleen is currently working towards her Certificate in Manual Physical Therapy and Certificate of Achievement in Pelvic Health. Colleen believes in looking at the body as an entire system rather than piecemeal parts in order to treat the whole person.