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.

As depicted in the image, the big toe curves towards the adjacent toes, while the bone positioned behind it (1st metatarsal) protrudes outward. This exerts a significant amount of pressure on the joint at the base of the big toe (first metatarsophalangeal joint). The inward bending of the big toe leads to the formation of a bunion, which creates a sharp angle at the joint.

Initially, the bunion consists of swollen tissue that becomes inflamed by external pressure, such as tight-fitting shoes. Over time, this swollen tissue thickens and forms a large lump, commonly known as a bunion. There is a widespread misconception that there is a direct correlation between bunions and footwear, but in reality, this is not entirely accurate. Cultures that do not wear shoes experience the same frequency of bunions; however, they may not report discomfort until their feet become arthritic.

Nevertheless, shoes can contribute to the development of bunions. Certain types of shoes, such as high heels, pointed shoes, ballet shoes, excessively tight shoes, ski boots, and cowboy boots, can accelerate the bunion formation process. Additionally, having low arches, flat feet, or hyper-mobility joints can increase the risk of developing bunions, regardless of whether one wears shoes or not.

ANATOMY AND BIOMECHANICS

Bunion formation triggers a biomechanical cycle of dysfunction. As the bone positioned behind the big toe (1st metatarsal bone) moves outward, the inner arch of the foot becomes unstable, causing it to collapse. The lack of support in the arch amplifies the stress on the angle where the bunion is forming, thereby accelerating the formation of the bunion. Consequently, this further destabilizes the arch of the foot. To effectively address this issue, it is essential to tackle both foot instability and joint angle.

Apart from the strain induced by inappropriate footwear, walking with your feet turned outwards can also contribute to bunion formation due to the pressure exerted on two specific muscles - the adductor hallucis and the abductor hallucis.

The adductor hallucis muscle has a unique "number seven" shape and runs from several of the lateral toes to the big toe. Contraction of the adductor hallucis muscle pulls the big toe towards the second toe.

The adductor hallucis muscle can become tight and constricted, causing the big toe to be continuously pulled towards the second toe, even without contraction. This restriction commonly occurs in individuals who excessively pronate or walk with their feet turned outwards, a large percentage of runners and dancers fall under this category.

The constant pulling of the adductor hallucis muscle disturbs the crucial balance in muscle tension, which typically maintains the big toe in a neutral or straight position. This equilibrium involves the adductor hallucis and abductor hallucis muscles. The abductor hallucis muscle normally resists the pulling action of the adductor hallucis and runs from the heel (calcaneus) to the big toe (proximal phalanx).

Sustained pulling from the adductor hallucis muscle weakens and overstretches the abductor hallucis muscle. In the absence of appropriate counter-balancing by the abductor hallucis muscle, the big toe moves inward, accelerating the formation of a bunion.

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 are a common foot condition that affects the joint at the base of the big toe. While many people believe that shoes are the sole cause of bunions, this is not entirely accurate. Bunions can also arise due to genetic factors, foot shape, and other conditions that affect the foot's biomechanics. Nevertheless, shoes can exacerbate the condition, particularly high heels, pointed shoes, and tight-fitting shoes.

Non-surgical treatment options, such as addressing joint mobility, wearing proper footwear, and utilizing taping, warm soaks, and custom orthotics, can help slow down the progression of bunions and relieve pain. Additionally, exercises such as the Pen and Loonie exercise and foot and ankle strengthening routines using a Theraband can also help increase intrinsic muscle foot strength. Ultimately, consulting a qualified practitioner is the best course of action for individuals seeking effective and tailored treatment for their bunions.

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

1. Ortiz, C., Wagner, E., Mignemi, D., & Parks, B. G. (2021). Bunions (Hallux Abducto Valgus). In StatPearls [Internet]. StatPearls Publishing.

2. 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.

3. Menz, H. B. (2005). Alternative techniques for the clinical assessment of foot pronation. Journal of the American Podiatric Medical Association, 95(3), 283-292.

4. Bonnel, F. (2008). Metatarsalgia and hallux valgus. Foot and ankle clinics, 13(2), 233-249.

5. 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.

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