It’s safe to say that as runners, we’re all too familiar with maladies of the feet. One of the most common amongst us: bunions. A bunion is an (often unsightly) protuberance at the base of your big toe. It forms when the metatarsophalangeal joint (MTP for short) is stressed over a prolonged period of time, causing the first metatarsal to turn outward and the big toe to point inward. The resulting protrusion can be painful—especially when it chafes within shoes. Some people can also form a bunion at the base of the pinky toe as well, known bunionette (and sometimes misdiagnosed as a Tailor’s bunion).

Identifying Symptoms of Bunions

Bunions are fairly easy to identify. If you have a knobby protrusion at the base of your big or pinky toe, it’s likely a bunion. Your doctor, a podiatrist, or a physical therapist can verify your hunch during an exam. He or she may want to take an X-ray to determine its severity. You may also be alerted to the formation of a bunion if the protrusion starts rubbing against shoes causing discomfort and pain.

Bunions can be particularly painful for runners, both because running in the wrong shoes can exacerbate them, but also because they can lead to other foot problems. If you start to unconsciously shift your weight off the painful big toe as you run, you may develop discomfort in the ball of your foot. The big toe can dive over or under the other toes, causing corns or hammertoes to develop.

Common Causes of Bunions

There may be a hereditary element to bunions, and having low arches, flat feet, or loose joints can increase your risk of developing them. In some cases, arthritis is to blame. Lack of strength in the muscles of the foot and wearing narrow, pointed-toe footwear are also causes. This is thought to be one of the reasons women tend to get bunions more than men—they’re more likely to wear tight, high-heeled shoes. But even ill-fitting running shoes can be to blame, says Ray McClanahan, D.P.M., podiatrist at Northwest Foot & Ankle in Portland, Oregon.

Most running shoes have a tapered toe box (that is, they get narrower at the toe) as well as a slightly elevated heel known as the “drop.” Wearing this sort of running shoe year after year is a recipe for bunions, says McClanahan, who is a long-distance runner. McClanahan often references what our feet looked like when we were babies: Our toes are splayed out wider than the rest of our foot. Interestingly, shoes for babies are still designed to accommodate this natural foot shape which aids a child’s balance when learning to walk. “But at two years old, we literally start making miniature versions of adults’ shoes,” he says. “We start deforming our toes.”

Indeed, in shoeless societies, deformities like bunions, hammertoes, and plantar fasciitis, are so rare as to be non-existent. (If you doubt this, take a look at Dr. William A. Rossi’s seminal article called “Why Shoes Make Normal Gait Impossible,” in which he lays out how, in industrialized societies, foot deformities are directly caused by faulty footwear.)

Though you probably wouldn’t classify your running shoes as high heels, take a closer look. Most running shoes have a 2:1 heel-to-forefoot ratio. This is designed to tilt you forward when you run, an ideal running posture. But what that does over time is shorten your Achilles tendon, which in turn weakens and flattens your arch. This—coupled with a tapering toe box that squashes your big toe into the space that should be occupied by the second toe—can create… you guessed it: a bunion.

Bunion Pain Relief and Treatment

Treatment for bunions starts with changing your shoes. High heels are definitely a no-no, as they tip the body’s weight forward, forcing your toes into the front of the shoes. Applying ice to your bunion and/or using acetaminophen, ibuprofen, or even cortisone injections can help control the pain in the short term. Using moleskin, gel-filled pads, or shoe inserts for arch support may also help.

If these conservative treatments don’t provide relief, the next step is to see a professional. When the bunion starts causing pain that impacts activities of your daily life like walking or running, many conventional podiatrists will recommend surgery as a next step. There are many types of bunion surgeries, but in most cases, the operation involves shaving back the big toe and severing the “adductor hallucis” muscle between your big toe and the next toe. Full recovery can take six months to a year, depending on the exact procedure.

During the 15 years he spent as a podiatrist, McClanahan performed hundreds of bunionectomies. What he saw is that surgery is not a permanent solution. “If a runner had surgery and went back to running in the same type of running shoe they had before the surgery, their bunion would come back,” he says. That’s because their big toes were still being held in a partially dislocated position.

At his Portland practice, McClanahan has a three-pronged regimen for reversing bunions. Hundreds of his patients with bunions—many of them bunions—have seen results with these natural methods.

1. Wear a Toe Spacer

McClanahan’s branded version is called “Correct Toes.” Think of Correct Toes as braces for your toes—it helps train your toe bones back into natural alignment. Or you can try a similar product such as Yoga Toes. McClanahan has patients with bunions wear the toe spacers around the house for just 30 minutes a day at first. (Don’t get overzealous. Some patients, thinking more is better, have worn them to bed and wake up with debilitating leg cramps.) Eventually, you can wear them in your shoes and even while running. Yoga toes work well when lounging or during a yoga practice.

2. Try Wider Running Shoes

McClanahan also recommends wearing running shoes that are wider at the end of the toes than at the ball of the foot and that do not have an elevated heel—what is known as “zero drop.” On his site, McClanahan has a Correct Toe-approved shoes. (That is, they are wide enough to accommodate wearing toe spacers.) In the running shoe category, Altra, Topo, Lems, and Vivobarefoot top the list. He recommends starting with a more supportive shoe like Altra or Topo—both of which are seen as “transition shoes” to more minimalist running shoes—and working your way down to more minimal shoe. (Transitioning to any shoe too quickly can cause injuries—but especially a minimalist shoe so practice caution.)

Maggie Fournier, D.P.M., president of the American Academy of Podiatric Sports Medicine, is on board with the wide-toed running shoes, but she’s less enthusiastic about zero drop shoes. “You have to be careful. It can trigger other issues,” she says. For this reason, McClanahan recommends slinging your new pair around your shoulder (or carrying them in a small backpack), running for a few miles in your old shoes and then doing just 1/4 to 1/2 a mile in the new pair, gradually working up to the full length of your run.

3. Do a Bunion Massage

A bunion massage stretches the adductor hallucis. “You take the toe out and you get inside there. People with a bunion will have a trigger point, where the muscle got short,” he says. Once you find it, rub there. Do this as often as possible. One 59-year-old patient did this for hours a day while watching soap operas and, according to McClanahan, saw a “remarkable decrease” in her bunion in only 9 months. (See the detailed instructional video on his site.)

Bunion Prevention & Added Benefits

You can prevent bunions by wearing comfortable, wide-toed shoes and avoiding narrow, tight, high-heeled shoes. Wearing toe spacers and massaging the adductor hallucis may help, too, though there is no definitive research showing that either prevent bunions.

McClanahan has submitted a study to the Journal of Sports Rehabilitation that shows how runners who wear Correct Toes and wide-toed running shoes have a statistically significant improvement in balance. Until those results are made public, Fournier at the AAPSM has this to say about Correct Toes: “The worst it’s going to do is nothing. You might as well use them for 30 minutes a day!”

There are added benefits to this regime, too. Since most of the muscles of the feet and lower legs insert into the last toe bone (the distal phalanx), when people start wearing toe spacers, other parts of the body improve, too. “People come back and they think we were just working on their feet, and they say, ‘Jeez. My core engaged’ or ‘My cervical spine feels better.’” That’s the amazing part of the kinetic chain—it’s all connected.