My goal with this thread is to compile as many experiences and perspectives as possible when it comes to bunion surgery (specifically) and returning to climbing. I've read a bunch of good posts on MP so far related to various pathologies of the foot, including bunions, but am still feeling uneasy about the outcomes. I'm facing distal osteotomy and bunionectomy for a mild case of hallux valgus, and am feeling nervous about the potential for loss of ROM, increased stiffness in the joint, or any other issues that could arise.
Please chime in if you've had bunion surgery and how the outcomes have been. Thank you!
I had a visit with Dr. Christina Weber in Boulder, and she recommended a distal osteotomy due to mild hallux valgus and persistent joint pain. For the record, I have tried alternative therapies like PT, toe spacers, and modified footwear. Sadly, the condition continues to progress...
I got a second opinion from Dr. Brian Gradisek (also in Boulder) and he recommended a Scarf Osteotomy which is slightly different than the traditional Chevron/Austin Osteotomy (distal). The Scarf uses a number of cuts along the metatarsal bone, and in his opinion is not only more effective but results in a faster recovery. His approach is that the quicker the patient can get the joint moving, the less scar tissue formation resulting in minimizing decreased ROM. I went ahead and scheduled surgery for mid November.
Still hoping to hear from anyone on their experiences, cheers!
I've had bunion surgery on both feet, one foot about 10 years ago and the other 3 years ago, with good results. The bunions were relatively mild but they'd progressed to the the point that climbing and trail-running was quite painful (the sesamoid bones had drifted out of place). I can't recall exactly what procedure was used but I believe it was chevron osteotomy or some variant. If you were physically active before surgery that makes a big difference to the recovery time. Both times I was off crutches after three days, stationary biking after a week or so (with a "walking cast", i.e. a big, rigid sandal) and driving after two weeks when it was my right foot. I can't remember how long it was before I started climbing again, but the most recent surgery was in early April 2016 and by end-May I was back to trail-running. No signs of any recurrence. I was quite diligent about stretching exercises during recovery. There's been a slight reduction in the big toe's range of motion but it hasn't bothered me at all.
Thanks Martin that is great news! Glad to hear your recovery was successful. I have surgery scheduled for my left foot, though my right foot looks almost identical (minus being symptomatic). I guess I shouldn't be surprised if I end up needing the surgery for the right as well (my mom had both feet done), but I'll just keep fingers crossed for now.
Bumping this again. I decided last minute to postpone surgery and try prolotherapy as recommended by Dr. Hecker in Fort Collins. I'm still in quite a bit of pain and am feeling discouraged. I'd appreciate hearing some more experiences on the topic of bunion surgery. Thank you!
I had a chevron bunionectomy 5 years ago because of foot pain that got progressively worse. I didn’t climb back then. I was bedridden for 3 weeks with my leg elevated, in a boot until 8 weeks post op, and back in a sneaker after 8 weeks. I normally have a high tolerance for pain, but found recovery to be very long and painful. I started doing yoga again at 3 months post-op and had to modify quite a bit. I probably didn’t jump back into chaturanga 1.5+ years. I’m the end, my foot is great. I lost a little bit of range of motion in the toe, but I still have lots.
I’m really glad I had it done. I’ve been completely pain free since it healed. It doesn’t affect my climbing whatsoever. I would have climbed worse with the bad toe... I did struggle for a very long time to find an aggressive shoe that didn’t make me want to cry. I’m not sure if that’s because of the surgery or because my feet are delicate. But, once I found a brand and last I loved, all was good.
Hey Maya, thanks for sharing and it's really awesome you had a positive outcome in the end!
Update on my journey: I had 3 prolotherapy injections over the course of 6 weeks, followed by 6 Piezo treatments all at Dr. Hecker's office in Fort Collins, CO. At the end of it all, my toe still feels pretty damn awful. Dr. Hecker assured me that over the next month things would improve, but I am quickly losing confidence in his approach. The Piezo treatments had short term improvements in my pain, but overall I am basically worse than when I started the prolo. Dr. Hecker's approach continues to be "Just keep walking, no running or jumping. No stretching and no strengthening of the foot yet. That will come later."
I have been in a custom ankle/foot brace since the start of the prolotherapy. It is basically a walking ankle brace attached to a rigid carbon fiber footbed that fits inside the shoe. This is designed to limit range of motion and increase support, without having to wear a full blown medical boot. Dr. Hecker released me from the ankle portion of the brace after Piezo #6, and told me at this point I should wear the carbon fiber plate in my shoe if I walk more than about 1.5 miles. Otherwise I don't need to wear any part of the brace. He also prescribed me an OTC orthotic that I'm supposed to wear for the next 6 months. He also prescribed physical therapy for about the next 6 weeks, indicating that the therapist would not be working on my foot, but instead on correcting any issues with my gait that may have caused the issue in the first place.
Well, I went to Jonathan Claude, lead therapist at High Country Physical Therapy in Laramie, WY. This was my second time seeing him, first time was for low back pain. Unfortunately I cannot recommend him. I honestly feel like it was a waste of time. Now, finding a good PT is very hard in my experience. I have probably seen 10 different PT's in the last 10 years, and I would only recommend a single one - Derek Haverley at Colorado In Motion in Fort Collins, CO. I quickly cancelled my remaining visits with John and got in with Derek 2 days later. Derek immediately agreed that we needed to get things moving again. He did a thorough assessment, did some dry needling, and then we went over an awesome routine for foot and toe strengthening. My toe has already improved since the visit (my other biggest improvement since starting the Prolotherapy was when I was finally allowed to take that damn ankle brace off).
At this point, I am seriously considering scheduling the surgery with Dr. Gradisek in Boulder, CO (excellent doc BTW). I am on a bit of a time crunch and need to be at least mostly healed up by May 1st, and hopefully climbing again by June-July. I do not regret trying the prolo, as it may have helped heal a sprained MTP joint, but I'm starting to believe that my pain stems more from "walking around with a partially dislocated toe" as Dr. Gradisek said as opposed to a torn ligament. This has been a tricky process so far, but I wanted to save surgery as a last resort. I think I may have arrived. Thanks for reading and I'll continue to update!
Bump for any more experiences with bunion surgery? Well, after another 6 weeks of rest and PT, my pain continues to prevent me from doing much of anything besides light hiking. I tried a short session at the gym in my mountaineering boots, hoping that the stiffness of the soles would allow me to climb. It was painful but somewhat tolerable on typical 5.9-5.10 plastic. I have opted for surgery once again, Bunionectomy with Scarf Osteotomy, scheduled March 16th with Dr. Brian Gradisek in Boulder. At this point I am feeling better about my decision as I feel I have exhausted all other options. I am excited and hopeful to put this all behind me. Doc says I'll start PT on week 2, twice a week for 6-7 weeks, then I'll technically be clear for all activity with pain being the only limiting factor. I hope to be hiking with a pack by week 7, and climbing in traditional climbing shoes by week 11-12. Once again I appreciate any feedback or comments!
Hi Mitch. I hope your surgery goes well. Please post up your progress. I think I am headed in that direction. Did a long climb yesterday and throbbing today. So frustrating...the rest of my body is ready to climb today but that stupid toe says no.
Could you share what brand/model the OTC orthotic was?
Hey Valerie, I'll definitely be updating this thread with my progress. Not a whole lot of feedback so far, but I'm hoping my experience can at least help people in the future. The orthotic that Dr. Hecker prescribed is called Vasyli Prior. It was a total gimmick and I promptly returned it. I would be very careful with any type of orthotic, whether OTC or custom. It is true that they can help manage pronation, which may be helpful short term for specific pathologies or pain relief, but long term they cause significant atrophy of the intrinsic foot muscles. It wasn't until I ditched the prescription brace, started walking around barefoot, and doing foot strengthening exercises that my condition improved to its current state.
Sorry to hear about your toe! Have you been dealing with it for very long?
This is a little late, but I actually had bunion surgery on both feet on December 16 (almost 3 months ago). My timeline was supposed to look like this: 2 days to get out of bed, with crutches. 2 weeks to walking without crutches. 1 month to move from post-op shoes to open toed sandals. About 1.5 months to wear closed-toed shoes. 2 months to run, jump, and climb, but no climbing shoes until 3 months.
I was climbing about 2 weeks later (without doc's knowledge) in the gym doing like 5.4 - 5.8 TR in the post-op shoes, and VERY carefully. I had to climb entirely on my heels/sides of my feet to avoid pain, and if anything would hurt I'd stop. Began wearing regular sandals to climb about a month post-op, still avoiding pressure on the toes because it hurt. I was extremely cautious in all other aspects of healing & had a pretty much perfect recovery. I started bouldering again & wearing my climbing shoes around 2 months and have been wearing them since, but only because they are Tarantulaces and are not tight at all. Now I am almost 3 months post-op and climbing the same as I used to. I have to wear spacers between my big toe and 2nd toe whenever I wear shoes to prevent the big toe from pointing back in. The only thing I can't do without pain is lunges.
My left foot had a worse bunion than my right, and I get occasional pain in that foot but not related to climbing, just randomly happens sometimes. I have almost full ROM back in the right big toe but left not as much. However consistently doing the ROM exercises that the doc prescribed has absolutely helped and I think it will return over time.
Worth noting though that I am very young (19yo) and that's probably partially why recovery went so well. However I had an excellent doc who did a great job. And now my shoes fit a lot better from not having a massive bulge at the ball of my foot.
Mitch Musci wrote: Bump for any more experiences with bunion surgery? Well, after another 6 weeks of rest and PT, my pain continues to prevent me from doing much of anything besides light hiking. I tried a short session at the gym in my mountaineering boots, hoping that the stiffness of the soles would allow me to climb. It was painful but somewhat tolerable on typical 5.9-5.10 plasitc. I have opted for surgery once again, Bunionectomy with Scarf Osteotomy, scheduled March 16th with Dr. Brian Gradisek in Boulder. At this point I am feeling better about my decision as I feel I have exhausted all other options. I am excited and hopeful to put this all behind me. Doc says I'll start PT on week 2, twice a week for 6-7 weeks, then I'll technically be clear for all activity with pain being the only limiting factor. I hope to be hiking with a pack by week 7, and climbing in traditional climbing shoes by week 11-12. Once again I appreciate any feedback or comments!
Hey Mitch, I've had this surgery on both feet, both sides of my feet so that's two bones (big and little toes).
My recovery period was quite long, I had a walking boot on for about 6 weeks. I was about 6 months from full mobility and power realistially. However when I had each surgery, when I was more active and less sedentary I gained a lot more mobility on that side vs the one where I was more cautious. It was swollen a lot and painful but recovered better when I wasn't sitting down as much and was doing a lot of walking even to my discomfort. I am a very active person though, so depends on your base-fitness.
As for climbing, mine was so bad I was not able to wear climbing shoes until afterwards so I can't comment in regards to recovery to wear a climbing shoe afterwards.
You could probably climb right now gently, just without the leg : ) and It's recommended to keep fitness. Also you can hangboard and do core. Get on it!
Thanks for sharing Alice and Brittney! I just had my surgery and am on day 2 of recovery. Day 1 was a bit rough. Initially the Percocet max dose wasn't touching the pain, so I switched to Dilaudid which did help take the edge off. Throbbing was pretty intense, but overall pain never went beyond about 6 out of 10 (my 10 being getting kicked in the chest by a mule). Day 2 and I'm down to 4/10 pain and off the pain meds for now. I may take one at bed time but I'm feeling like I've turned the corner in that regard.
Now this is all while laying down. I definitely can't put any weight on my left foot, and even standing up while balancing on my right foot causes waves of intense, throbbing pain. This is all pretty manageable, just describing this experience for anyone who might be curious or looking into the surgery. Basically day 1 post op really sucked, and by day 2 I'm already doing better.
The doc described the timeline like this: first 48 hours in bed, then afterwards the number of weeks post operation equals the number of hours I can spend on my feet. So week 2, I can spend 2 hours on my feet, week 3 is 3 hours, etc. I have a medical shoe that I must wear for the first week, but then afterwards any athletic shoe with laces and moderate support will do. Dr. Gradisek's priority is getting the foot/joint moving ASAP to prevent scar tissue formation, so my PT starts on day 10. He was very specific to say no running or jumping right now, and the best cardio exercises are either biking or swimming. Once I complete week 7, I will have full clearance for all activity, pain withholding. Until then, I am not allowed to load the toe in dorsiflexion under any circumstances (so for example traditional pushups while balancing on the toes is not allowed). Trying to climb on my heel isn't really worth it to me, so I'll plan on hangboarding, pullups, and whatever core exercises I can manage until then.
I'll keep my updates rolling, thanks for following along and for sharing your stories!
So picking up where I left off, I haven't touched pain meds since day 3. The waves of throbbing pain when moving from laying to standing continued until about day 10, but the duration became shorter and shorter. I took my first shower on day 9 (had a bath on day 7 with foot out of the tub) and holy shit the pain was intense. The hot water turned my foot purple and my nerves went crazy. Needless to say, that was one of the quickest showers of my life. Since then, the pain has been slowly but steadily decreasing. Ice has been key, and I try to use it at least a few times per day.
Before and after X-Rays:
The doc said surgery went very well. Aside from correcting the deformity, he said there was significant synovitis surrounding the sesamoid bones, which he was able to clean out. He also made a cut in the phalanx and anchored it in a more medial orientation. This has left me with a super straight shot from tarsal to distal phalanx and I'm stoked!!
Here are a couple of photos from day 9 post shower:
And a couple photos from day 17:
I'm very thankful to have avoided any signs of infection, and feel like I'm well on my way to recovery at this point. The doc gave me this interesting exercise tool called the Bioskin Hallux Control Strap that allows me to easily plantarflex at the MTP against resistance. I do about 3 sets of 50 reps, 3 times per day. This forms the foundation of my toe strengthening. I had 2 PT sessions on days 10 and 14, both of which were spent reintroducing movement to the joint in all planes, gentle stretching/scraping/traction, and prescriptions for starting with some ankle mobility exercises. By day 14, my PT was encouraging toe dissociation exercises, balancing on the affected foot, and even more aggressive exercises like short foot. By the way, the book - Whole Body Barefoot: Transitioning Well to Minimal Footwear by Katy Bowman has everything you need to get the toe rehabed and strong. Just keep in mind that you need to take things slow and carefully, and don't expect to go minimal right away. Due to the COVID-19 circumstances, I have started cancelling PT appointments due to my confidence in this book, and the initial direction from my therapist. Always keeping in mind the definite restrictions I mentioned earlier: no loading the toe while in dorsiflexion, and no running or jumping.
I have a scraping tool called the "Wave Tool" that I use gently about every other day all over the affected foot. This helps break up scar tissue. I have also started rolling out the bottom of my foot with a baseball. While I have always done this from standing, it's just too much pressure so I have found gentle rolling from a seated position to be quite adequate for now. I'm also trying to start incorporating some walking into my rehab. On day 14 I walked a mile, and later regretted it! Now on day 17 I'm managing about a half mile, and I'm wearing a roomy leather boot with a carbon fiber footbed for extra stiffness.
Speaking of footwear, I still can't get my foot into a normal athletic shoe. The swelling is still significant enough and the foot is still quite sensitive to tighter fitting footwear. However, I have been carefully moving around the house barefoot which feels awesome! I pretty much ditched the medical boot on day 14, but still use it for stretching my gastroc and soleus (the stiff sole helps quite a bit with this stretch). Also of note - I have been wearing a light compression band around the surgery site, but I imagine in another week it won't be needed anymore.
Finally, I have been able to return to hangboarding and core work. Weeks 1 and 2 I just felt too distracted, but am happy to be moving forward with that again. I do pushups with my lower shins on a foam roller to keep my toes off the ground. Side planks seem to be ok as is, and things like glute bridges (not to be confused with planks - use a foam roller on the shins for this) are just fine. Once I can get to walking a mile in my stiff boot without pain, I may begin my transition to a more flexible shoe. The bottom line is that some doctors' protocol specifies non weight bearing for 5 weeks, and here I am hobbling around quite fine on both feet by the end of week 2. Again, one of the keys to a successful outcome is minimizing scar tissue formation via mobility and strengthening, but minimizing swelling. You definitely want to find a balance here, as going too hard will increase swelling and set you back in your recovery. But spending 5 weeks in bed is the last thing you want to do! I definitely have a bit of a limp in my gate, but it's more mental than actually avoiding physical pain. Re-wiring my brain to evenly weight the foot while walking will certainly be a challenge I expect to have in the coming weeks, but an important one to address. Well that's about all for now, I'll definitely keep updating. I realize there are plenty of blogs out there that outline the healing process from bunion surgery, but I wanted to make one more climbing specific. Cheers!
So picking up where I left off, I haven't touched pain meds since day 3. The waves of throbbing pain when moving from laying to standing continued until about day 10, but the duration became shorter and shorter. I took my first shower on day 9 (had a bath on day 7 with foot out of the tub) and holy shit the pain was intense. The hot water turned my foot purple and my nerves went crazy. Needless to say, that was one of the quickest showers of my life. Since then, the pain has been slowly but steadily decreasing. Ice has been key, and I try to use it at least a few times per day.
Before and after X-Rays:
The doc said surgery went very well. Aside from correcting the deformity, he said there was significant synovitis surrounding the sesamoid bones, which he was able to clean out. He also made a cut in the phalanx and anchored it in a more medial orientation. This has left me with a super straight shot from tarsal to distal phalanx and I'm stoked!!
Here are a couple of photos from day 9 post shower:
And a couple photos from day 17:
I'm very thankful to have avoided any signs of infection, and feel like I'm well on my way to recovery at this point. The doc gave me this interesting exercise tool called the Bioskin Hallux Control Strap that allows me to easily plantarflex at the MTP against resistance. I do about 3 sets of 50 reps, 3 times per day. This forms the foundation of my toe strengthening. I had 2 PT sessions on days 10 and 14, both of which were spent reintroducing movement to the joint in all planes, gentle stretching/scraping/traction, and prescriptions for starting with some ankle mobility exercises. By day 14, my PT was encouraging toe dissociation exercises, balancing on the affected foot, and even more aggressive exercises like short foot. By the way, the book - Whole Body Barefoot: Transitioning Well to Minimal Footwear by Katy Bowman has everything you need to get the toe rehabed and strong. Just keep in mind that you need to take things slow and carefully, and don't expect to go minimal right away. Due to the COVID-19 circumstances, I have started cancelling PT appointments due to my confidence in this book, and the initial direction from my therapist. Always keeping in mind the definite restrictions I mentioned earlier: no loading the toe while in dorsiflexion, and no running or jumping.
I have a scraping tool called the "Wave Tool" that I use gently about every other day all over the affected foot. This helps break up scar tissue. I have also started rolling out the bottom of my foot with a baseball. While I have always done this from standing, it's just too much pressure so I have found gentle rolling from a seated position to be quite adequate for now. I'm also trying to start incorporating some walking into my rehab. On day 14 I walked a mile, and later regretted it! Now on day 17 I'm managing about a half mile, and I'm wearing a roomy leather boot with a carbon fiber footbed for extra stiffness.
Speaking of footwear, I still can't get my foot into a normal athletic shoe. The swelling is still significant enough and the foot is still quite sensitive to tighter fitting footwear. However, I have been carefully moving around the house barefoot which feels awesome! I pretty much ditched the medical boot on day 14, but still use it for stretching my gastroc and soleus (the stiff sole helps quite a bit with this stretch). Also of note - I have been wearing a light compression band around the surgery site, but I imagine in another week it won't be needed anymore.
Finally, I have been able to return to hangboarding and core work. Weeks 1 and 2 I just felt too distracted, but am happy to be moving forward with that again. I do pushups with my lower shins on a foam roller to keep my toes off the ground. Side planks seem to be ok as is, and things like glute bridges (not to be confused with planks - use a foam roller on the shins for this) are just fine. Once I can get to walking a mile in my stiff boot without pain, I may begin my transition to a more flexible shoe. The bottom line is that some doctors' protocol specifies non weight bearing for 5 weeks, and here I am hobbling around quite fine on both feet by the end of week 2. Again, one of the keys to a successful outcome is minimizing scar tissue formation via mobility and strengthening, but minimizing swelling. You definitely want to find a balance here, as going too hard will increase swelling and set you back in your recovery. But spending 5 weeks in bed is the last thing you want to do! I definitely have a bit of a limp in my gate, but it's more mental than actually avoiding physical pain. Re-wiring my brain to evenly weight the foot while walking will certainly be a challenge I expect to have in the coming weeks, but an important one to address. Well that's about all for now, I'll definitely keep updating. I realize there are plenty of blogs out there that outline the healing process from bunion surgery, but I wanted to make one more climbing specific. Cheers!
Congrats! I purchased shoes a few sizes too big specifically for post-surgery that were very supportive.
Also a weird one -- I had phantom pains for a while, maybe a year afterwards (weird right?!) even though the bone technically wasn't there any more, so that's normal :)
Hey Lena, I'm 37. Sorry to hear you are hurting. This would be a good time for me to throw out some potential remedies for those looking to avoid surgery (which should be everyone BTW!)
Ever since I cured my shin splints and plantar "fasciitis" by transitioning to minimal footwear and wearing toe spreaders, I have been a big proponent of the whole movement. I'm not going to get into barefoot running, nor will I argue that going minimal/barefoot is the only way, but I will say that I have personally reaped many benefits of such an approach. Many others including doctors and scientists agree that a key aspect of foot health involves re-empowering the foot by ditching traditional footwear. Check out this video on plantar "fasciosis" and toe spreaders:
Generally speaking, those opposed to the idea cite 2 main arguments: it's just a fad that has come and gone, and statistics show it does way more harm than good. First of all, in terms of pop culture it is correct to label it a fad. When Born to Run came out, people went nuts (killer book BTW) and enthusiasm for barefoot/minimal has now waned. This is because of 2 main reasons - 1) People are lazy. They tried some Vibram Five Fingers, then realized they looked ridiculous and gave up. Or they wore them around for a couple months and missed how coddling traditional shoes felt, so again they gave up. The other main reason is 2) People got injured. They did too much too fast, and quickly ended up with overuse injuries (mostly in the context of running). This is the main argument used by pedorthists. They say "look at the studies" Indeed, most studies are limited to 6-8 weeks, some as short as 1 week! Not only does this transition take an awful lot of time and dedication, some of us will probably never fully adapt. When you walk around in a soft cast for 10-20+ years, including the duration of adolescence, there are some things that cannot be undone. Again, the most prominent hurdles come from transitioning to running either barefoot or in minimal footwear. My experience has been that walking and hiking, even with a heavy pack on uneven terrain, is a very reasonable and attainable goal.
Those who believe in the barefoot/minimal approach tend to cite a few major benefits: It implements proper strengthening of the intrinsic foot muscles, it improves proprioception which allows for a healthier state of locomotion, and longterm it acts as a pathway to injury prevention. Here is a link to a bunch of great articles discussing the topic: https://www.correcttoes.com/foot-help/articles-studies/
Again, I'm not here to tell you what to do. I recognize that just like diet, foot health is highly personal. Some people spend their whole lives in traditional footwear and never have foot problems. This would support the notion that at least some of this tendency towards or away from injury is genetic. In other words, some people may be more predisposed to anatomical deformity when placed into a restrictive state. But this isn't to say that lack of injury = health. I would argue that everyone would increase proprioception by reducing the amount of material between their foot and the ground. Think about it - when was the last time you walked around barefoot outside of your house? Do you remember walking around barefoot in your yard as a child? The way the grass and cool earth felt under your foot? It's an incredible feeling...one that too many of us have forgotten. Some sources say there are more nerve endings on the sole of your foot than anywhere else on the body. Numbers aside, there is a specific evolutionary component here that should be recognized. There is a reason why we have so many damn nerves on our sole - because the feedback they transmit to our brain is extremely important! The more we hinder this feedback system, the more awkward locomotion becomes. One could say "nonsense, I have awesome balance and no problems with walking/running". That could be entirely true. The human body is an amazing adaptive machine. But one thing is for sure, we ain't gonna grow nerves on the soles of our shoes.
Unfortunately as climbers, we are fighting a losing battle by wearing climbing shoes. I am one of those people who may harbor a genetic predisposition to deformity. My mom had bunion surgery on both of her feet. I grew up with a lot of foot problems and even wore custom orthotics as a kid. When I discovered toe spreaders 6 years ago, some things instantly improved, but I kept shoving my feet into little torture chambers. Granted, for the most part I size my climbing shoes to be appropriately accommodating. My trad shoes are a true "all day" fit, and even my tightest bouldering shoes go on without trouble (none of this plastic bag nonsense). I've had doctors tell me "it's not the time you spend inside the climbing shoe that matters, it's the time outside the climbing shoe that makes the difference." I can see the logic - if you take 20,000 steps round trip for a climb, and only climb 3-5 pitches, the 20,000 steps probably have more impact. But if you think about the acrobatics your toes do - especially your big toe - while being loaded with a ton of force and squeezed into a tapered position, I would imagine the logic isn't so cut and dry.
Not to mention, most climbers are walking those 20,000 steps in approach shoes or trail shoes with tapered toe boxes and exaggerated drop. So maybe approaching with a wide toe box/zero drop shoe would be enough to counter the assault caused by the climbing shoe? In a perfect world - yes. This is what I've been doing for the last 6 years. I had an incredible revolution when I transitioned to minimal footwear. I took it slowly at first, and progressed within a year to 10-15 mile days, on and off trail, many times with an overnight pack, and my feet had never felt better. Simultaneously, my brain was freaking out (in a good way) due to the sensations that had been muted for so long. Then one summer, I climbed D7 and on the descent noticed some new kind of pain in my left big toe, right at the MTP joint. A few days later the pain mostly went away, but each year I started noticing it more and more, and it was obvious that climbing shoes were the culprit. This past August, I was doing some cragging at Lumpy Ridge and this time the pain came for good. I could barely walk later that day, and haven't put my foot in a climbing shoe ever since.
So moving forward, here are some potential remedies that continue to help with my symptoms. Check out the toe extensor stretch and soft tissue release:
Thanks for the share, all of you guys. I will be following this with interest. I’d appreciate some advice as well, but I’ll share a few details of my own first. I’ve been an climber, backpacker, and trail runner for years. In 2016 I was preparing for the Columbus marathon and simultaneously getting ready for a climbing trip out to Yosemite. All the years leading up to this, I had never really paid a whole lot of attention to my footwear. If it felt good, was economical, then I got it. So what happened? I climbed in YNP and I started noticing my foot was hurting and shoes felt bad but it was after my marathon where my big toe joint was throbbing with pain. Someone pointed out I had a bunion, I just never noticed or really paid attention. The pain was so bad I stopped running for months and saw an podiatrist (nearly worthless – but I’ll return to that). On the first visit, my foot was x-rayed and examined. The x-ray showed arthritis and a mild bunion. The opinion was that it was due to the bad mechanics in my foot causing the bunion and the action taken was a casting of the boot and some orthotic inserts. I tried explaining my concerns about running and climbing shoes but the doctor had nothing to offer, except to say that the malady may, or may not worsen. So I was left to figure out everything else on my own. My solution was to switch all my footwear to anything with a wide toe box, stiff-soled, and add arch support. I also select climbing shoes that are as asymmetrical and as roomy as I can find. If it restricts my climbing then so be it. I also use arch supporting orthotics and try to do a lot of single leg balancing poses in my yoga to strengthen the feet as well as exercises with golf balls. And I too also use toe spacers. It makes my afflicted foot feel a lot better. So where does that leave me? I am only 34 now and I may be slowing the progression of the bunion down and I can still climb without pain, but I feel that at some point, the time will come when it is necessary. What’s weird is that if the bunion is what is causing the arthritis, why wouldn’t they operate in advance to save as much of the joint surface as possible? Who would you guys recommend seeing for this and how did you select your physician? When I was in the podiatrists, I got the impression they were more about fitting diabetics and elderly with shoes and taking care of gnarly toe nails than they were athletes who squeeze their feet into terrible shoes and then beat their feet up.
Hey Tony, it sounds like you are in a very familiar conundrum that a lot of athletes face. First, I'd say you are doing several things right - balancing exercises, toe spacers, wide toe box footwear. I saw 4 doctors and got 4 different opinions about surgery. Unfortunately, there is a wide spectrum of ideas and opinions about foot health amongst the medical community. I'd recommend checking out some of the links I posted, both videos and books, to get more in-depth info on the topic.
Your questions are also familiar: who should I see and what should I do? More tough things to answer. I'm happy to give you my opinion, and while I'm no doctor I've done a ton of research on the topic of foot health. First, it sounds like you may have taken a break from running, but if not then I do recommend going this route. I love (and miss) trail running dearly, but I'm just not at a point to re-incorporate it back into my routine. For people that are experiencing foot pain and problems, running tends to exacerbate it (or even be the cause of it). While I pledged earlier to NOT get into barefoot/minimal running, I am a proponent of this approach but also recognize it takes time and dedication to adapt. If you are careful and patient then go for it, but I believe it's best to skip the running for now.
Secondly, a good strengthening and flexibility program is key. Get your foot strong, do the exercises regularly. Stretch, massage, scrape. Transitioning to minimal footwear will speed this part up. *Try* ditching your orthotics, but go slow. Walk around barefoot in your house, or even outside on mellow trails. Build up to hiking longer distances in minimal footwear. Keep wearing the toe spacers - Correct Toes fit quite well inside shoes if you modify them appropriately. My experience is that all of these things can slow down the progression of a bunion. I highly doubt they have the power to reverse a bunion though. If you think about spending years and years in footwear that pushes your big toe inwards, the counter affect would be to have a device that literally pulls it in the opposite direction during activity. A toe spreader just props it into a more correct anatomical position, which can alleviate symptoms.
As for doctors, talk to lots. Generally, docs will say RICE short term and surgery if that doesn't help. More insightful docs will recommend changing footwear and PT before surgery. As for joint health, I was lucky in that I had very mild arthritis and plenty of cartilage left in the joint. As you may know, the X-ray doesn't directly show cartilage, rather the space that it occupies. My surgeon agreed that getting the surgery earlier vs later has generally better outcomes, but this is a tricky conclusion to reach and depends on how bad the joint is. A badly deformed MTP with little cartilage left is just not going to get much better with the above strategies, but a milder case could see symptom alleviation to the point that activity can resume. For how long is anyone's guess. Again, we are fighting a losing battle with climbing shoes. My surgeon had worked with many climbers in the past, and even though his solution didn't really involve trying any of the above strategies, his track record was excellent and his experience made me more comfortable with moving forward. He had specific reasonings on why he chose Scarf Osteotomy over Chevron/Austin and I appreciated that. Finally, he emphasized his approach of getting the joint moving ASAP to prevent scar tissue, which I was totally onboard with. If your doctor is telling you several weeks or more non-weight bearing post op, find a different doc! I hope this helps.
My last condition update was right around 2 weeks, and I was hobbling around but in good spirits. Weeks 2-4 were all about adjusting to the "gimp" lifestyle and focusing on the small gains. Most activities remained mild to moderately painful outside of slow-paced, around the house chores. I regularly went for 1 mile walks on smooth terrain just to keep the blood flowing, and these went well enough minus a slower pace and a limp in my step. Around week 3 I was finally able to fit into my trail running shoes for these walks (though barely), and I continued wearing my rigid footbed on the left side. PT was a gradual progression of balancing and strengthening exercises, slowly incorporating more load onto my left foot. For the entirety of my home PT, I found a day on/day off routine was best for allowing full recovery between exercise sessions.
Right around week 4 was when things got interesting, and I was beginning to walk at a normal pace. The small gains were coming on a daily basis, and I would often notice certain things just didn't feel as painful from day to day. The swelling was still quite noticeable, but much improved. Week 5 was when I first started noticing specific improvements compared to my pre surgery status - specific pain I would have in my MTP while pronating was now less than it had been in months!
At week 6 I got cocky and went for a 2 hour mountain bike ride. I had done a couple of short test rides, and realized I could push on the pedal with the middle of my foot and not induce pain. Indeed, throughout the ride I was doing quite well, but the next day I was in pain. Unfortunately it took 4-5 days to get back to where I was pre ride, and I was a bit nervous about the situation. At week 7 I had another follow-up with my doctor, and after taking new xrays he concluded that my bones had fully healed and I was cleared for all activity! He reiterated that I would still need to take it slow, and that setbacks would continue without a moderated approach. The soft tissue still needs lots of time to heal - up to a year realistically speaking. It was definitely a reality check to hear him say "You're definitely not out of the woods yet, but headed in the right direction."
So how am I feeling? Well, my chief complaint is definitely extension of the great toe. It feels stiff, with decreased ROM both active and passive. I am now doing standing calf raises and it's fairly painful, but both my PT and doctor encouraged me to tolerate moderate pain with this type of exercise - it needs to be strengthened, and gains in this department should improve my symptoms. So I'm doing 3 sets of 20 calf raises, 3 times a day in addition to my standard routine. Hopefully I'll start to see some strength gains during the next 2 weeks and can move on to 1-legged calf raises and bear crawls. It's pretty obvious at this point that I'm not ready to climb, but with full clearance for activity I'll now be pushing my pain threshold more regularly, and again I'm hoping this will speed up the re-strengthening process.
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