As drummers, we rely on our feet to be able to repetitively push a pedal hundreds of thousands of times per year. Regardless of if we play heel up or heel down, a tremendous amount of force is applied across our feet and toes. Those of us that have developed a painful swelling and or deformity of the big toe know how debilitating this can be to walk or run normally let alone play the drums.
A bunion is a structural deformity of the bones and the joint between the big toe and the foot. Bunions, also referred to as hallux valgus or hallux abducto valgus, is often described as a bump on the side of the big toe. The big toe often turns in toward the second toe and the tissues surrounding the joint, the bursa, may become swollen and tender. Bunions are a progressive disorder with symptoms usually appearing at later stages. However, some people never develop symptoms.
Bunions are usually caused by an inherited biomechanical abnormality in the foot, where certain ligaments, tendons, and other supportive structures of the first metatarsal bone are no longer functioning correctly. This abnormality may be due to a variety of structural conditions of the foot such as abnormal bone structure, flat feet, excessive ligamentous flexibility, or certain neurological conditions.
It remains controversial whether poor fitting shoes are the cause or only exacerbate the problem. The pressure that elevated heels put on the toes is more pronounced in those with bunions. Other symptoms include irritated skin around the bunion, pain when walking, joint redness and pain, blister formation over the bunion, and a shift of the big toe toward the other toes.
The treatment of a bunion initially is always conservative, including changes in the types of shoes worn (shoes with a wider toe box, flat, or minimal heels), different orthotics with accommodative padding and shielding to minimize pressure on the bunion, rest, ice, and medications, including oral anti-inflammatory, as well as topical medications.
When conservative care has not been effective, treatment by an orthopeadic surgeon or podiatrist may be necessary. There are a number of surgical procedures that remove the boney enlargement or realign the great toe. Lifestyle, health, and age play a significant role in the choice of procedure. Recovery typically takes from six to eight weeks with residual swelled occurring up to six months after surgery with activity.
Relying on feet to drive the beat, drummers must recognize abnormalities, deformities, or discomfort and seek proper care before that beat is silenced.