Bunionettes: A Lesser-Known Chronic Injury

Feet are the workhorses of any long-distance undertaking. They do the lion’s share of the work and take the most damage of any body part. They get cold, wet, and sweaty in the name of transporting you from point A to point B and ask little in return except to be cared for. Sometimes, even if you’ve managed to escape the blisters and black toenails, your feet end up breaking down in other ways, which can affect your ability to put in the miles you want on a daily basis.

Some of the most commonly reported foot injuries on the Appalachian Trail include plantar fasciitis, Achilles tendonitis, and ankle sprains. While these conditions can indeed be problematic, there exists a plethora of information with which to reference and learn the various ways to recover. During my 2018 thru-hike, I successfully avoided these particular foot injuries yet fell victim to a sneaky and troublesome chronic injury called a bunionette, also known as a tailor’s bunion.

Bunionette – The Bunion’s Wicked Stepchild

Cedars Sinai describes a bunionette as, “similar to a bunion, but occurs on the outside of the foot. It is a raised portion of skin that often becomes irritated and sore.” Although less common than traditional bunions that appear near the big toe, bunionettes can be just as painful and disruptive to someone who is on their feet all day (e.g., a thru-hiker). Bunionettes are also known as tailor’s bunions because the clothing tailors of yesteryear commonly sat cross-legged with the outsides of their feet rubbing against the ground, causing bunionettes to form.

Bunionettes are caused by pressure and trauma to the outside of the foot as a result of poorly fitting shoes, arthritic conditions, or misalignment of the metatarsals (toe bones). They typically develop gradually and worsen over time, getting more painful and swollen as the condition continues and the body reacts by adding bone, further exacerbating the effect. Thru-hikers are particularly susceptible to tailor’s bunions because of the shock and damage that their feet are experiencing on a daily basis for months on end.

My bunionettes post-hike.

Treatment of bunionettes typically doesn’t require surgery, although it’s an option if other fixes don’t work. Non-surgical treatments involve changing shoes to a pair that have a wide toe-box (e.g., Altras), wearing sandals, or applying some kind of pad or cushioning to soften the impact. In some extreme cases, surgery can be used to realign the metatarsal or shave down extra bone that has accumulated.

My Story

Before hiking the AT, I had run a handful of ultramarathons and was already a proponent of Altra shoes. I never experienced foot pain during any of my training or races, so I figured I had my footwear dialed in. I started the trail wearing a pair of Altra Timps, which I had used to set the FKT for a little-known trail on the island of Cyprus just a couple of weeks before and they felt great. However, by the time I reached Damascus, VA ,they were toast and I was having some worrisome IT band issues that had me second-guessing my shoes. I switched to a pair of Oboz Sawtooth hiking shoes, which didn’t work for me at all, and soon after began feeling the bunionettes worsen as the stiff sole wore down my newly formed callouses.

A wet day on the trail provides good skin contrast – you can see the callous around the bunionette just below my pinky toe and my raw midsole from the Oboz shoes.

The pain was gradual at first, but after a couple of weeks it would be excruciating within just a mile or so of walking in the morning. Not knowing what was causing the irritation, I googled my symptoms and discovered bunionettes. I started taking ibuprofen a couple of times per day, which I hated having to do since everything else felt great, but it helped. As time and miles went on, I ended up switching shoes three more times in an effort to provide some relief to the swollen and inflamed abscesses.

The shoes I ended up finishing with were the New Balance Kaymins, which were the only pair of trail shoes I could find in a wide size. Although I missed the zero-drop and foot-form features of my beloved Altras, I tried a couple of pairs on and they just weren’t wide enough for my bloated feet. If I went up in size any more they’d become too long and unwieldy, so I needed to go with something that had a wide base all the way through rather than just at the toe box.

Evolution of my footwear on the AT. Starting bottom R to L: Altra Timps, Oboz Sawtooth, Topo Terraventure, Altra Olympus, New Balance Kaymin.

By the time I switched to the extra-wide Kaymins in Hanover, NH, my bunionettes were beyond help. Even with the extra space, the impact of the roots and rocks of New England eviscerated them more and more, to the point where I was taking 800mg of ibuprofen per day just to put in average miles.

In addition to swapping shoes and taking ibuprofen, I also tried using some silicone bunionette pads, which I hoped would add a bit of cushion to the area and reduce pain, but unfortunately their flimsy design didn’t keep them in place, and within a mile of walking the pads would be twisted and tangled inside my shoes, usually ending up on top of my foot rather than on the side.

In the end, the only fixes for me were to have an extra-wide shoes and take ibuprofen religiously. My feet hurt all day, every day, and I don’t think I could have put up with it much longer. More than food or rest, I was most looking forward to foot comfort after finishing.

After the Trail

Once I finished my journey, I immediately took a week off with almost no physical activity. My feet stopped hurting and I didn’t take any more ibuprofen. My bunionettes, however, didn’t go away. I started doing some light running a couple of weeks later and could feel them throbbing after a handful of miles, but it was nowhere near the level it was during the hike ((not walking around with a 25 pound pack may have helped).

A month after finishing the hike, the bunionettes had improved, but I nevertheless decided to see a podiatrist to make sure there wasn’t something more serious going on that I needed to address.

Calloused bunionette on my left foot – still puffy and calloused a month after finishing the AT.

The podiatrist took some X-rays of my feet and while he was able to confirm that I hadn’t crippled myself, there was a slight calcification on my left pinky toe that the doctor said was probably the cause of some pain.

The doctor also measured the angles between my metatarsals and said they aren’t too askew, so he didn’t have any major concerns with the condition of my feet. We discussed treatment options for the bunionettes and he recommended Altra shoes (go figure) and perhaps a shoe stretcher that could help widen the shoe further. He noted that the zero-drop feature on Altras can help take some of the pressure off my forefoot that is normally applied with a higher-drop shoe since it shifts the impact of the step to the middle of your foot instead of the front. If Altra made extra wide shoes that could accommodate these behemoth growths, I’d be all for it. Unfortunately, their newer models seem to have a slimmer body and so I’m not sure they’ll work for me. Until the swelling permanently decreases on my bunionettes, I’ll continue wearing wider shoes to alleviate some of the discomfort.

Summary

Bunionettes, aka tailor’s bunions, are swollen lumps that appear on the outside of the foot and are caused by restrictive footwear and/or misalignment of the metatarsals. If not treated, they can become extremely painful and a real burden while attempting to thru-hike. Mine formed after the first 400 miles and worsened until I was medicating the pain away for the remainder of my hike. Although I was very happy with my daily mileage, the bunionettes had a negative impact on how well I felt throughout the day.

After seeing a podiatrist at the conclusion of my hike, I found out that I didn’t have many treatment options aside from surgery and shoe modification to provide relief. At this point, I’m not ready to go under the knife and will instead focus on pain mitigation through wider shoes and more rest. I’m hoping to train for another ultramarathon early next year, and my recovery from this and the AT in general will likely dictate the possibility of that endeavor.

 

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Comments 15

  • Avatar
    Greeter Too : Aug 14th

    Congratulations on finishing the AT. Thanks so much for this information. I have been on a quest to find wide track runners that are truly wider. The new Saloman’s wide track runner are actually narrower than the an older regular model. I ordered the Kaymins just now and am hoping they will help, plus consulting with my podiatrist.

    Reply
    • Avatar
      Brandon Chase : Aug 14th

      Happy to help and thanks for reading! Hope the Kaymins work for you – I think I would have been better off had I started with them instead of waiting until the last section, but you don’t know what you don’t know. Good call on consulting with your podiatrist as they will be helpful in determining any other conditions you might be working with. Good luck!

      Reply
  • Avatar
    Adam "Catch-Up" Dawson : Aug 14th

    Brandon,
    Firstly, congratulations on completing your thru-hike despite the 1800 miles of foot pain! I’ve read a number of your blogs, great stuff very informative! I’m also a native Maineiac grew up in Brewer moved to Pa after serving in the Coast Guard I life a few miles off the trail near Boiling Springs. My 17 year old son “Rabbit Foot” and I are thru hiking next year, we’ve currently section hiked 900 miles of the AT together over the last 6 years. He plans on attempting to break FKT unsupported pf The 100 mile wilderness in under 35 hours 20 min. When he was. In 8tth grade we did the 100 MW in 3 days prior to summiting Katahdin (which I was the slow factor).
    Having had bunions since childhood and in my 20s I frequently they would be painful in particular shoes and driving I’ve not had any issues since the last 15 years. Footwear was always a struggle until finding Altra’s (my bunions are quite large and have pushed my big toe inwards and caused the next toes to lift somewhat over) I’ll have to give NB Kaymins a try, though I love Ultra LP. This article was very helpful thanks for sharing. Best to you in your next ultra. I’m by no means a runner butt did my 1st 50k trail race last year great time a lot of training and learning experience.
    BTW, would it be possible for myself or my son to contact you? he’s looking for a ultra training plan.
    If you’re interested he applied to Trek as. Vlogger and I blogger, his YouTube page https://www.youtube.com/channel/UCKIijlmckFsvUue4izV2z7Q
    Instagram @rabbit.foot
    My https://youtu.be/tVxqwMiITds
    Insttagram @adam.dawson.hikes
    Look forward to reading about your future adventures!
    Catch-Up

    Reply
  • Avatar
    Adam "Catch-Up" Dawson : Aug 14th

    I recently got the SWD 40L pack also, couldn’t agree more amazing pack!

    Reply
    • Avatar
      Brandon Chase : Aug 14th

      Hell yeah! Love that thing.

      Reply
  • Avatar
    TBR : Aug 14th

    Interesting report on your foot travails.

    I’d seen this happen to hikers’ feet, but did not know it was an actual thing, with a name.

    That X-ray is fascinating — tells the tail of too-tight shoes.

    What, by the way, does “zero-drop” mean?

    Reply
    • Avatar
      Brandon Chase : Aug 14th

      Thanks for reading! “Zero drop” means that there is no differential between the height of the heel and forefoot in the shoe (as if you’re standing in bare feet). Most running shoes are higher at the heel, resulting in a “drop”. Altra claims that their zero-drop techology “aids in optimal alignment, cultivates better form, and encourages a low-impact landing”.

      Reply
  • Avatar
    Adam "Catch-Up" Dawson : Aug 14th

    Brandon,
    Firstly, congratulations on your completing your thru-hike especially despite your 1800 miles of dealing with foot pain issues. I read many of your blogs, good stuff very informative.
    I’ve had bunions since childhood and for a few years in my 20s they were painful especially when driving or not having the right footwear. Fortunately the last 155 years or more. I haven’t had any pain and finding Altras few years ago was a huge blessing for my feet! My bunions are quite large in size over time they’ve caused my big toes to push inward causing them under the next toes.
    I also am a native Maineiac, was born in Bangor grew up in Brewer and moved to Pa after serving in the Coast Guard where I live
    a few miles of the AT near Boiling Springs. My 17 year old son “Rabbit Foot ” and I have section hiked 900 miles of the AT together over the last 6 years and are beginning a thru-hike together beginning next March 22nd. I currently wear Alttra LP but will have to give NB Kaymins a try. When my son was in 8th grade we brought a couple thru hikers to Maine, we hiked The 100 Mile Wilderness in 3 days then summited Katahdin (I was the slow factor) my son is planning to attempt FKT unsupported pf the 100 MW under 35 hrs 20 min. I ran my first 50k

    Reply
    • Avatar
      Adam Catch-up : Aug 14th

      Opps I hit send accidently.
      Brandon, I’ve only ran few trail races 50k kast year and few 15ks while my sons mile time surpasses me by over 3 min its difficult to train with him lol I was wondering if you might have any training plan suggestions for him? While he has run a 20 mile trail race a little over a year ago slightly under 3 hrs a couple of 15k trail with 4000′ elev gain in 1 he 15-20 range and running a 50k trail in a few weeks. In addition, we recently applied to blog The Trek and my son Vlog
      Rabbit Foot//Aubrey YouTube https://www.youtube.com/channel/UCKIijlmckFsvUue4izV2z7Q
      Instagram @rabbit.foot
      My YouTube https://youtu.be/tVxqwMiITds
      Instagram @adam.dawson.hikes
      Thanks for all the great blogs and much success in your training and upcoming ulttra.
      Catch-Up

      Reply
      • Avatar
        Brandon Chase : Aug 14th

        Hey Catch-Up!

        Thanks for writing – always good to hear from another Maine-iac. I grew up on Mount Desert Island, not too far from you in Brewer/Bangor! Sounds like you’ve had some great adventures and it’s really awesome that you and your son are thru-hiking next year. Your start date is right around when I began and it was ideal to miss a lot of the nasty weather. Rabbit Foot sounds like a tremendous athlete as well, so I’m sure you guys will have a great time

        I don’t have any specific training plans to recommend, although I did publish my own plan for my first 50k race in 2017 and I thought it worked really well. Here’s the link if you want to check it out: http://www.fitformiles.com/50k-plan/

        As for the shoes, if Altra LPs work for you then keep at it! If I hadn’t developed the bunionettes I probably would have stayed with Altras as well, but things change. As much as you hear people talk about Altras on the AT, there are other options so just keep that in mind.

        Enjoy your training – I loved the section near Boiling Springs even though it rained the whole time I was in PA.

        – Brandon

        PS – nice YouTube channel! I was a wrestler in high school as well and later an official, so it was cool to see those vids in addition to your hiking content. Keep it up!

        Reply
        • Avatar
          Adam Catch-up : Aug 14th

          Thanks Brandon for the response and encouragement! Ah MDI one of my favorite places ever! My son was quite competitive as a wrestler nationally ranked in top 50 his freshman year last year he was wrestling up 4 weight classes in a internationally freestyle tournament got thrown on his head suffered a severe concussion which he lost his memory for a couple months thankfully he fully recovered. He suffered another few months after which he decided to not risk a 3rd and which he planned to thru hike is finished with HS in this Jan took college classes over summer to substitute for his HS class. I’m blessed that he asked me to do AT with him. Besides wrestling

          Reply
  • Avatar
    Brian Lewis : Aug 14th

    I had bunionettes before I did my first thru-hike ten years ago, and was also told that my options were (a) get surgery or (b) buy shoes with a wide toe-box. Though the same podiatrist kept trying to put me in big-assed boots for other foot issues (and THAT wasn’t happening).

    I hiked the PCT using Golite shoes 10 years ago. Not super durable, worked for the bunionettes but I think led to me getting surgery for Morton’s Neuroma just based on how the sole lugs were configured.

    Switched to ASICS, and did great with those, Gel-Kahanas, nominally 1-1/2 sizes to big and in 4E width. Hiked the AT and the CDT in those. On the CDT I gave my pair to a hiking partner in New Mexico after I had 600 miles or so on them because they were still in better condition than what he had.

    But — the newer generation of Gel-Kahanas are a lot less durable in the heel area, basically bits of the shoe start falling off less than 300 miles in. Shoe-goo saved my ass on the PNT and again just last month hiking with friends in NorCal and around lake Tahoe.

    I literally just ordered a pair of a different model of ASICS that don’t look like they’ll have the same issue; I was considering New Balance shoes instead, because they too come in 4E.

    If this happens again to you on a long trip, consider literally cutting the sides of the shoes by the base of your little toes. This is such a PITA condition because a pair of shoes can feel fine in my living room or in a showroom floor, I figure I have to walk 50 or so miles or so in a pair of shoes before I’m sure that increasing feeling of aching isn’t going to come over me, turning the shoes into yet another pair of “use at home only” gardening type shoes. I personally am not confident that one can “stretch out” these kinds of shoes the way you can leather footwear.

    What I do when I have to look for new shoes is to go to zappos.com, who pretty much always shoe a variety of views of a shoe. Search to find trail runner brands that come in 4E width. Then look at the views from top-down and bottom up, focusing on how much the shoe seems to bulge out in the toe-box at the base of the toes on the little-toe side. Then buy a pair and try them out. A lot. If I’m pretty sure they’ll work, wait for a sale if possible and then buy eight pairs because the process is such a PITA. But don’t wait too long else by the time I find a decent sale they can be close to the end of their model year, can’t find shoes in my size and width, have to start over with the new model which they’ll inevitably have tweaked. PITA.

    The ASICS I’m trying are the Gel-Venture 6 model. I suspect that they’ll work in general, but I’m now leery about ASICS due to durability; I literally had a hole going all the way through the bottom of the heel of my Gel-Kahana’s after about 300 miles in a pair of these on the PNT. If these don’t work, I’ll try New Balance.

    Reply
  • Avatar
    Brandon Chase : Aug 14th

    Brian,

    Thanks for the AWESOME information! You could probably write a whole book on this condition with all the experience you have. It sure is a PITA, but I’m glad to know there are others like you who are successfully managing it and still hiking big miles.

    I appreciate all the tips about cutting the shoe (I was almost at that point on the AT) and how to shop for 4E sizes. I’ve definitely got a growing stack of “around the house only” shoes due to this and it’s very frustrating. Durability is also an issue, as you mentioned, and it seems like a never-ending struggle to find something that will last. I was pleasantly surprised with how well the Kaymins held up – they were still in pretty good shape after the Whites and all of Maine.

    What’s the next adventure for you?

    – Brandon

    Reply
  • Avatar
    Adam Catch-Up : Aug 14th

    Sorry darn phone keyboard issues lol.
    All the traveling 8-10 months of the year to tournaments we always enjoyed time section hiking together he meeting thru hikers. Sorry we missed you we do lots trail magic weekends in Pa during the bubble. You guys encountered more rain than I can ever recall…definite mental toughness! I’ll definitely check out your plan much obliged!!!

    Reply
    • Avatar
      Brandon Chase : Aug 14th

      Awesome! Keep crushing it!

      Reply

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