Updated: May 4
Bunions (Hallus Abducto Valgus) are a common foot problem that affects the joint at the base of the big toe (first metatarsophalangeal joint). In Latin “bunion” means enlargement, while “hallux abducto valgus (HAV)” refers to a bending inwards of the big toe as seen on the below image.
As you see, the big toe bends in towards the other toes while the bone behind it (1st metatarsal) pushes outward. This creates a considerable amount of stress on the joint (first metatarsophalangeal joint). Due to this bending inwards, a sharp angle at the big toe joint is created, resulting in the formation of a bunion.
Initially, this enlargement is composed of swollen tissue which becomes irritated by any external pressure (for example tight shoes). Eventually this swollen tissue thickens to form a very large lump or bunion. There is an obvious relationship between bunions and shoes, since bunions do not occur in cultures that go barefoot. High heels, pointed shoes, ballet shoes, excessively tight shoes, ski boots, and even cowboy boots often lead to the development of bunions. Also Low arches, flat feet, and hyper-mobility in joints and tendons all increase the risk of developing bunions.
ANATOMY AND BIO-MECHANICS
From a bio-mechanical perspective, bunion formation creates a cycle of dysfunction. As the bone behind the big toe (1st metatarsal bone) moves outwards, the inner arch of the foot becomes unstable and starts to collapse. This instability, or lack of support in the arch, increases stress on the angle at the point where the bunion is forming. This stress accelerates the formation of the bunion, which in turn further destabilizes the arch of the foot. To truly deal with this problem, you must address both the foot instability and joint angle. In addition to the stresses caused by poor shoes, simply walking with your feet in a "turned out" position can also lead to bunion formation from the stress it puts on two particular muscles, the adductor hallucis and the abductor hallucis. The adductor hallucis is an interesting muscle which is shaped like the number seven. The adductor hallucis transverses from several of the lateral toes into your big toe. When the adductor hallucis contracts, it pulls the big toe towards the 2nd toe.
When the adductor hallucis muscle becomes tight and restricted, it continually pulls the big toe towards the second toe (even without contracting). The adductor hallucis tends to become restricted in individuals who excessively pronate or walk with their feet turned outwards (a huge percentage of runners and dancers). This pulling action of the adductor hallucis disrupts a key balance in muscle tension, which normally keeps the big toe in a neutral or straight position. This balance occurs between the adductor hallucis and the abductor hallucis muscles. The abductor hallucis normally resists the pulling action of the adductor hallucis. The abductor hallucis runs from your heel (calcaneus) to your big toe (proximal phalanx). Constant pulling from the adductor hallucis weakens and overstretches the abductor hallucis. Without the appropriate counter-balancing action of the abductor hallucis, the big toe moves inward, and bunion formation accelerates.
NON SURGICAL TREATMENT
The objective of non-surgical treatment is to prevent the progression of the bunion by correcting the bio-mechanical stress on the foot, by realigning the joint as much as possible, and by increasing the intrinsic strength of the foot.
Below are some videos demonstrating the type of procedures we could use to address bunions. The types of procedures we use will vary greatly depending on each individual case. We would also address both soft tissue and joint mobility restrictions.
Note: These videos are for demonstration purposes only. MSR procedures should only be performed by a qualified practitioner.
Plantar Fasciitis - Foot Procedures - MSR: Though this video is about Plantar Fasciitis, the same restrictions that lead to Plantar Fasciitis also lead to bunion formation. Restrictions in the soft tissue structures of the foot can cause gait imbalances that could lead to the formation of bunions. It very common to see bunions in patients that come in to be treated for Plantar Fasciitis.
MSR - 7 Point Ankle & Foot Mobilization: Improving joint mobility is critical if you are going to effectively address the body's full kinetic chain. In fact, we greatly reduce the effectiveness of any myofascial treatment if we don’t also address restrictions in joint mobility. The objective of joint mobilization is to reverse adverse physiological changes by promoting movement between capsular fibers.
Shoes with narrow toes, and with higher heels can trigger a bunion. There is a reason why bunions are 10 times more common in women, women wear heels.
In most cases, bunion pain can be greatly reduced by wearing wider shoes, with a low heel and a softer sole. Making sure the shoe has adequate room for your toes to move around. You have to decide, which is more important, a particular style of shoe or being in constant pain?
Bunion Spacers – Only Temporary Relief
In my experience toe spacers, or bunions splints can provide short term relief. Certainly, after bunion surgery they can help when ligaments, tendon and soft tissues are healing. What bunion spacers don't do is correct the underlying problem.
Bunion taping can help reduce pain and discomfort of a bunion (short term) by helping to realign the joint taking pressure off the bunion. Taping helps bring the big toe back into a neutral position, taking pressure off of the first metatarsal joint.
Warm Soaks and Ice Packs
When your bunion is painful, use warm soaks with Epsom salts for 10 to 20 minutes. If that doesn’t provide relief then use an ice pack for 10 to 15 minutes. The ice will help reduce the inflammation and provide short term relief. My preference is definitely the heat, if you use ice to much it can actually inhibit the healing process.
Custom Fitted Orthotics
Custom orthotics can help slow down bunion progression. If the orthotic is made correctly, it can help straighten your big toe as you push off with your foot keep it in a more neutral position. This can reduce pain, swelling, and slow down any arthritic changes in the joint.
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.
Foundational Myofascial Foot Release - MSR: This video goes over the logic of doing a myofascial release of the foot. Then it shows you how to release the structures under your foot using a lacrosse ball in combination with some pin and stretch techniques. We often prescribe these myofascial release exercises with patient who have bunions or Plantar Fasciitis.
Increasing Big Toe Mobility - MSR: Having mobility in the joints of the big toe is essential for a normal gait. However, the joints of the big toe (MTP and DIP) are common sites of restriction. In addition the most common site of arthritis in the foot is at the base of the big toe.
Foot & Ankle Strengthening Routine - Using a Theraband: This foot and ankle strengthening routine works the flexor, extensors, internal and external foot rotators using a Theraband.
Great Bunion Exercise - Strengthening the Feet: We have found the following exercises to be very effective in treating bunions. This is just one exercise we would prescribe to patients with bunions. This exercise would be combined with several myofascial release exercises.
Pen and Penny (Loonie) Exercise: The Pen and Loonie exercise is a great way to increase intrinsic muscle foot strength. These muscles can become lazy from excessive use of shoes, especially those that support the arch of the foot.
My recommendation is to first try conservative care and exercise before considering surgery. In the majority of cases I have seen patients reduce their pain, increase their mobility, and vastly improve their overall function.
Conservative care may not eliminate the problem, but in many cases it does bring you back to a functional life where every step is NOT a constant pain. Make you appointment today!
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publication which will be available later this year.
Make an appointment with our incredible team at Kinetic Health in NW Calgary. Just scan the QR code with your phones camera and click the link, or call Kinetic Health at 403-241-3772 to make an appointment today!