Question: I am a 21-year-old woman who likes to jog. In the past year, I have noticed that the first metatarsal bone on my right foot has become larger, causing it to bend outwards while my big toe points inwards towards the other toes.
At times, it may even become swollen with an “arthritis-like” pain that comes and goes. Is this likely to be a bunion due to the constant stress and pressure exerted on my feet when jogging? If so, why is it happening on only one foot?
Also, I am a vegetarian and drink a fairly large amount of soya milk every day for my protein needs. Is my diet causing mild gout that aggravates the pain? How can I ease the pain and swelling, or realign my toe without having to go under the knife?
Answer: Pain and swelling around the first metatarsophalangeal joint, which is the big joint of the big toe, is a common problem.
As you have rightly pointed out, common causes include bunions associated with hallux valgus and gout. A hallux valgus deformity occurs when the big toe tilts towards the second toe. This is associated with a bump on the outside of the big toe known as a bunion.
Other causes of pain in that region include toe flexor tendon problems and degenerative or inflammatory arthritis, and more.
Given the symptoms you described, the problem is likely to be hallux valgus. Gout is less likely in your case, given the description of your feet.
Patients with hallux valgus often complain of pain around their first metatarsophalangeal joint. They will also have difficulty with choosing the right footwear due to the pain and swelling.
Although the condition is commonly observed on both feet, there are patients who experience it on only one foot.
Hallux valgus is commonly observed in women with a family history of the condition. Other risk factors include biomechanical abnormalities in the feet such as flat feet and loose joints. Prolonged wearing of ill-fitting shoes will also increase your risk of developing a bunion.
Consult a sports physician for a clinical assessment.
Treatment for hallux valgus depends on the severity of the symptoms. For mild cases, a short course of anti-inflammatory medication will help relieve the acute pain of inflamed bunions.
In the longer term, the correction of the biomechanical abnormalities in the feet is required. This can be achieved with the use of appropriate footwear, foot orthotics for pronation control, toe spacers and bunion cushions.
A trained podiatrist will be able to prescribe the right products after assessing your condition.
Maintain good mobility of your lower-limb joints through regular calf, hamstring and quadriceps stretches as they often impact the lower-limb biomechanics as well.
Surgery is a last resort for more severe cases which do not respond to conservative management.
Dr Ong Joo Haw
Consultant, Sports Medicine Centre, Khoo Teck Puat Hospital
Article first published on Straits Times