Bunions, also known as Hallus Abducto Valgus, are a prevalent foot issue that impacts the joint situated at the bottom of the big toe, also known as the first metatarsophalangeal joint. The term "bunion" originates from Latin and denotes an enlargement, while "hallux abducto valgus (HAV)" describes the inward bending of the big toe, as shown in the image below.
Article Index:
Introduction to Bunions
The image shows the big toe angled towards the other toes, with the 1st metatarsal bone behind it jutting out. This causes pressure on the joint at the base of the big toe, leading to a bunion formation characterized by a pronounced angle at the joint.
Initially, bunions present as swollen tissue, aggravated by external pressure from tight shoes. Over time, this swelling thickens, forming the noticeable lump known as a bunion.
While it's a common belief that bunions are directly caused by footwear, this isn't entirely true. Bunions occur at similar rates in non-shoe-wearing cultures, although discomfort may not be reported until arthritis sets in.
However, certain footwear like high heels, pointed or tight shoes, ballet and ski boots, and cowboy boots can hasten bunion development. Additionally, factors like low arches, flat feet, or hyper-mobile joints can increase bunion risk, regardless of shoe use.
ANATOMY AND BIOMECHANICS
The development of a bunion sets off a chain reaction of biomechanical issues. As the 1st metatarsal bone behind the big toe shifts outwards, the foot's inner arch becomes unstable and starts to collapse. This reduced arch support increases stress at the bunion's developing site, which in turn exacerbates the instability of the foot's arch. Addressing this problem requires focusing on both the instability of the foot and the altered joint angle.
In addition to tight or improper footwear contributing to bunion formation, walking with feet pointed outward also plays a role. This walking style puts pressure on two key muscles: the adductor hallucis and the abductor hallucis.
The adductor hallucis, with its distinctive "number seven" shape, extends from several lateral toes to the big toe. Its contraction draws the big toe closer to the second toe, influencing the development of the bunion.
The adductor hallucis muscle, when tight and constricted, can cause the big toe to be persistently drawn towards the second toe, independent of muscle contraction. This often happens in people who excessively pronate or walk with their feet turned outwards, which includes many runners and dancers.
This continuous pull from the adductor hallucis disrupts the necessary balance of muscle tension that usually keeps the big toe aligned. This balance is between the adductor hallucis and the abductor hallucis muscles. The abductor hallucis, running from the heel to the big toe, normally counters the pull of the adductor hallucis.
However, prolonged tension from the adductor hallucis can weaken and stretch the abductor hallucis. Without effective counteraction by the abductor hallucis, the big toe shifts inward, further contributing to bunion development.
Foot Anatomy (11 Muscles) - Motion Specific Release
In this video, we review the anatomy of 11 muscles of your foot, primarily those on the plantar aspect.
FOOT EXAMINATION
Effective Ankle and Foot Examination - In this video, orthopaedic tests are employed to assess some of the prevalent ankle and foot conditions observed in clinical practice. These conditions encompass Ankle Sprains (inversion sprain), Cuboid Syndrome, Talar Dome Lesions, 5th Metatarsal Fracture, Syndesmosis damage, Achilles Tendon Tendinopathy, Morton's Neuroma, 2nd Metatarsal Stress Fracture, Plantar Fasciitis, and Bunions.
NON SURGICAL TREATMENT
The aim of non-surgical therapy is to impede (or decelerate) the advancement of bunions by rectifying the biomechanical pressures on the foot, re-aligning the joint as much as feasible, and enhancing the intrinsic strength of the foot.
The following are two videos that exemplify the type of therapeutic approaches that may be employed to combat bunions. The treatment techniques utilized will vary considerably depending on the individual case, and we will also address any restrictions in joint mobility and soft tissue.
Please note: These videos are solely for demonstrative purposes. Procedures involving MSR should only be conducted by a qualified practitioner.
Best Bunion Exercises and Nonsurgical Treatment:
Dr. Brian Abelson illustrates in this video how to tackle a broader kinetic chain to fully alleviate bunions (Hallux Valgus). Miki Burton RMT describes some essential aspects that need to be taken into account when addressing this ailment. She subsequently demonstrates a series of highly effective bunion exercises (which can be found at the 09:35 time stamp).
MSR - 7 Point Ankle & Foot Mobilization: Enhancing joint mobility is a vital component in effectively addressing the complete kinetic chain of the body. Neglecting to address limitations in joint mobility can significantly reduce the efficacy of any myofascial treatment. The purpose of joint mobilization is to counter unfavorable physiological changes by encouraging movement between capsular fibers.
GENERAL RECOMMENDATIONS
Footwear
Wearing shoes with narrow toes and higher heels can trigger or worsen a bunion, which is why women, who frequently wear high heels, are ten times more susceptible to bunions than men. In most cases, wearing shoes with a low heel, a soft sole, and adequate room for your toes to move around can significantly alleviate bunion pain. It is important to prioritize comfort over a particular shoe style.
Bunion Spacers – Only Temporary Relief
Toe spacers or bunion splints can provide short-term relief, particularly after bunion surgery when the ligaments, tendons, and soft tissues are healing. Soft toe spacers that can fit into your shoes are highly recommended. However, bunion spacers do not address the underlying issue.
Taping
Bunion taping can help relieve pain and discomfort by re-aligning the joint and reducing pressure on the bunion. Taping can bring the big toe back into a neutral position, alleviating pressure on the first metatarsal joint.
Warm Soaks and Ice Packs
To alleviate bunion pain, warm soaks with Epsom salts for 10 to 20 minutes can be effective. If this does not provide relief, ice packs for 10 to 15 minutes can help reduce inflammation. However, excessive use of ice can hinder the healing process, and heat is preferred.
Custom Fitted Orthotics
Custom orthotics can impede bunion progression by correctly straightening the big toe during foot push off, keeping it in a more neutral position. This can reduce pain, swelling, and slow down any arthritic changes in the joint.
EXERCISES
The following exercises are examples of exercises that we could recommend for patients with bunions. Please note, this is just a sample of our exercises, the actual exercise routine will vary depending on each individual case.
Best Bunion Exercises and Nonsurgical Treatment:
In this video, Dr. Brian Abelson demonstrates how to address a larger kinetic chain to completely resolve bunions (Hallux Valgus). Miki Burton RMT. explains some key factors you need in order to address this condition. She then demonstrates some extremely effective bunion exercises (the time stamp for these exercises is 09:35).
Increasing Big Toe Mobility - MSR: Unhindered mobility in the joints of the big toe is crucial for maintaining a normal gait. Nevertheless, the joints of the big toe (MTP and DIP) are frequently prone to restrictions. Furthermore, the base of the big toe is the most prevalent location for arthritis in the foot.
Foot & Ankle Strengthening Routine - Using a Theraband: This exercise routine focuses on strengthening the foot and ankle muscles by utilizing a Theraband to target the flexors, extensors, as well as the internal and external foot rotators.
Pen and Penny (Loonie) Exercise: The The Pen and Loonie exercise is an effective method for augmenting the intrinsic muscle strength of the foot. These muscles can become inactive due to prolonged usage of shoes, particularly those that provide support to the arch of the foot.
EQUIPMENT:
Toe Separators at Amazon https://amzn.to/3WfQJFv
Theraband/Resistance bands at Amazon: https://amzn.to/3VWQheW
Yoga Mats at Amazon: https://amzn.to/3gzyfiO
CONCLUSION
In conclusion, bunions, or Hallux Abducto Valgus, present a complex challenge in foot health, requiring a multifaceted approach for effective management. As we've explored, these deformities not only affect the appearance of the foot but also lead to biomechanical imbalances and pain. The journey from initial bunion formation to more severe stages involves a range of factors, including footwear choices, walking patterns, and inherent biomechanical tendencies. Understanding these factors is crucial for both prevention and treatment.
Our exploration of non-surgical treatments, from tailored exercises to appropriate footwear and orthotics, underscores the importance of addressing the root causes of bunions. While these methods aim to slow the progression and alleviate the discomfort associated with bunions, they also highlight the importance of early intervention and ongoing foot care. Remember, each case of bunion formation is unique, and thus, requires a personalized approach to treatment and management. With proper care and attention, individuals can effectively manage this condition, ensuring foot health and maintaining mobility and quality of life.
DR. BRIAN ABELSON DC.
Dr. Abelson is committed to running an evidence-based practice (EBP) that incorporates the most up-to-date research evidence available. He combines his clinical expertise with the specific values and needs of each patient to deliver personalized care that is both effective and patient-centered.
As the developer of Motion Specific Release (MSR) Treatment Systems, Dr. Abelson operates a clinical practice in Calgary, Alberta, under the name Kinetic Health. He has authored ten publications to date and continues to offer online courses, in addition to his live programs, to healthcare professionals seeking to expand their knowledge and skills in treating patients with musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.
References
Ortiz, C., Wagner, E., Mignemi, D., & Parks, B. G. (2021). Bunions (Hallux Abducto Valgus). In StatPearls [Internet]. StatPearls Publishing.
Nix, S., & Vicenzino, B. (2010). Toe flexor strength and foot muscle architecture in adults with and without hallux valgus. Journal of foot and ankle research, 3(1), 1-6.
Menz, H. B. (2005). Alternative techniques for the clinical assessment of foot pronation. Journal of the American Podiatric Medical Association, 95(3), 283-292.
Bonnel, F. (2008). Metatarsalgia and hallux valgus. Foot and ankle clinics, 13(2), 233-249.
Cho, B. C., & Park, K. J. (2016). Effects of Theraband exercise on the flexibility and strength of the ankle joint. Journal of physical therapy science, 28(7), 2064-2067.
Nix, S., Smith, M., & Vicenzino, B. (2010). Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. Journal of Foot and Ankle Research, 3(1), 21.
Menz, H. B., & Morris, M. E. (2005). Footwear characteristics and foot problems in older people. Gerontology, 51(5), 346-351.
Nguyen, U. S., Hillstrom, H. J., Li, W., Dufour, A. B., Kiel, D. P., Procter-Gray, E., ... & Hannan, M. T. (2010). Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study. Osteoarthritis and cartilage, 18(1), 41-46.
Ferrari, J., Malone-Lee, J., & Murnaghan, M. (2004). Biomechanics of the first metatarsophalangeal joint in hallux valgus: a review. Foot and Ankle Surgery, 10(1), 5-12.
Torkki, M., Malmivaara, A., Seitsalo, S., Hoikka, V., Laippala, P., & Paavolainen, P. (2001). Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA, 285(19), 2474-2480.
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