Will Dancing Cause Bunions?

How many times have you heard that ballet or dancing causes bunions? The answer to that question is probably too many. ‘Bunions’ or the hallux abducto valgus deformity usually affects the big toe, and is commonly highlighted as a risk for particularly dancers. Read on to learn a bit more about the impact of dancing on bunions and other causes!

Causes

If dancing alone caused bunions, we would expect to see all dancers with bunions. Or, we would expect to see only dancers being affected by bunions. Dancing may indirectly be one of many contributing factors leading to bunion formation, but there are a large list of other, non-dance, contributors that usually have a greater direct impact on a dancer’s risk of developing bunions.

Genetics

The number one risk factor for developing bunions is genetics. A family history of flat feet (pes planus), hypermobility, a short or dorsiflexed 1st metatarsal or a combination of these factors all increase the risk of developing bunions by impacting the mechanics of the 1st toe. These can usually be objectively measured in a clinical setting.

Foot function

A second contributing factor are mechanical and functional changes in the feet. They include:

• Increased demand on the ball of the 1st toe during gait (while walking) or whilst completing daily tasks or activities.

• Poor intrinsic foot muscle control which can be due to injury, weakness or slow degeneration over time.

• Strength imbalance of the intrinsic vs extrinsic foot muscles

• Collapse of the medial arch of the foot through the ‘toe off’ portion during gait (walking).

Foot function can be tested in many ways from a gait analysis (an analysis function while walking) to specific movements, muscle tests and active tasks that can be prescribed by a podiatrist or allied health professional.

Environmental factors

The third umbrella of contributing factors to bunions is environmental factors - these vary in degree of impact but every person has their own unique set of risk factors. Environmental factors more commonly exacerbate bunion symptoms and rarely cause the formation of bunions themselves. They include wearing footwear that is too narrow, has a pointed-toe, has a shallow toe-box area, and wearing shoes that lack support to the rearfoot and midfoot regions. They may also include types activities eg. standing for long periods, change of direction sports and sports with specific footwear demands. Environmental factors may increase the risk factors from genetic factors to functional foot factors. Podiatrists are experienced in helping you to understand which of these environmental factors may impacting the formation of bunions for each person.

Which risk factors particularly affect dancers?

Dancers are at as much risk as any other person who displays similar genetic changes or foot function to them, whether they’re a dancer or not. Realistically, it is the environmental risk factors for bunions commonly associated with dance that draw all of the negative attention, but the impact of environmental factors vary too much between each individual dancer to be able to say that dance causes bunions. The environmental risk factors, specific to dancers, that increase the risk of bunion formation include:

• Tight, stiff, unique footwear that may be inadequate to support some dancers' foot types.

• More risk of mechanical changes from overloading and fatigue in intrinsic foot muscles than some other sports and activities. .

• More risk of injury and imbalance in muscles, ligaments and joint in the forefoot and surrounding the 1st toe than some other sports and activities.

• An environment where joint hypermobility needs to be very well managed by each dancer.

• Pressure for dancers with ‘flat feet’ to ‘work harder’ or wear pre-arched or aesthetically customised footwear that may further exacerbate impaired foot function and posture.

• Flat ground surfaces, often with inadequate shock absorption to match the activities.

Most, if not all, of these factors that could predispose dancers to a higher risk of bunions can be improved with the correct management and care. Thus, the misconception that bunions are caused by participation in dance is an oversimplification so large, it borders on a wives tale!