Hallux Valgus Deformity is commonly known as a bunion. A fluid filled sac called a bursa is positioned on the medial side of the metatarsophalangeal (MTP) joint of the great toe (where the great toe attaches to the foot). Hallux valgus deformity in and of itself is not a bunion, but bunions are more likely to occur in individuals with this abnormality. A bony prominence can form as a result of the abnormal shape of the MTP joint and this is referred to as a bunion. Bursitis (inflammation of the bursa) can also occur as a result of hallux valgus deformity.
Hallux valgus deformity is no more common in dancers than in the general population. Among dancers, however, bunions are seen more often in ballet dancers. Contrary to popular belief, bunions are not caused by ballet or dancing on pointe. However, improper technique, poorly fitting pointe shoes and a predisposition due to hallux valgus deformity can exacerbate them.
The most common occurrence of bunions in younger dancers is due to a congenital metatarsus primus varus. In other words, the great toe curves outward toward the center of the foot (away from the midline) causing the first metatarsal to take the bulk of the weight on pointe or demi-pointe. Forcing turn-out causes pronation, which can exacerbate bunions, as well as rolling forward or “winging” the foot while on pointe.
Dancers with bunions have developed a variety of techniques for padding the first metatarsal, including a U-shaped cushion over the MTP joint and spacers between the first and second toe. These techniques combined with meticulous attention to the placement of the foot and ankle while dancing as well as correct fitting of pointe shoes are likely the best approach. It is recommended that ballet dancers suffering from bunions are fitted with a higher vamp to support the MTP joint.
Surgical correction of the bunion is a possibility, but can lead to a reduced range of motion or sometimes total loss of function at the MTP joint. While this is of little concern in pedestrian life, it can greatly inhibit the ability to dance and should only be considered when all other methods have failed.
Secondary conditions can arise as a result of bunions, including metatarsalgia, stress fractures, sesamoiditis and flexor hallucis longus tendonitis.
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