Bunions in the Elite Athlete: The Philosophy and Principles

Introduction

Sports medicine physicians treat many problems. One important area is the foot and ankle, with bunions being a common complaint. What do you do when an athlete comes to your office and says “My great toe hurts and has developed a prominence”? This chapter is not an explanation of bunions and all the various treatments. You can review those treatments in other textbooks and articles.

Experience

What I want to do is share my experience of treating bunions, as well as secondary and tertiary problems, which develop as a result of bunions. I will also discuss other foot and ankle problems that support my philosophical approach to bunion treatment in the elite athlete. I don’t really care to review the literature, but rather prefer to outline my observations and outcomes of treating many elite athletes.

Between 1969 and 1974, all I saw was a bumpectomy, or a Keller bunionectomy during my internship and residency. In San Francisco I came under the influence of Henri DuVries, MD and Roger Mann, MD with a DuVries modification of the McBride procedure. I was also shown the Lapidus procedure where the tarso-metatarsal joint was fused along with the soft-tissue bunion reconstruction (McBride). Later Mann taught me his proximal first metatarsal (MT) osteotomy with a McBride procedure.

I came back to Houston, started jogging and running marathons during the running boom of the 1970s. Some of my friends and I started a running club in 1975, The Houston Harriers. I became the “go to” physician for joggers. I started a fellowship training program, and with my 35 fellows at University of Texas medical school and Baylor we started making observations and writing 27 peer review medical articles, many related to athletic injuries.

We looked at heel pain, bunions, Achilles tendon problems, as well as primary, secondary, and tertiary problems. I learned the Chevron bunionectoemy from Ken Johnson at the Mayo clinic in Arizona, later adding an occasional proximal phalanyx osteotomy (Aiken). Bill Hamilton, MD in New York taught me about treating ballet dancers’ bunions conservatively.

Philosophy

The trick to medicine, as I see it, is to first take a complaint, read everything there is in the literature about that problem, and ask yourself if the recommended treatments can be improved with better outcomes.

My philosophy of foot and ankle surgery of athletes evolved. It is not the final answer. Your treatments will continue to evolve during the many years of your practice.