Bunions - Stop That Burning Pain!

Updated: Nov 1


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. Most people think there is a causal relationship between bunions and shoes. The reality is that there is NOT. Cultures that do not wear shoes still have the same rate of bunions, they just don't complain about them (at least until their feet become arthritic).


That being said, shoes are a problem. Wearing high heels, pointed shoes, ballet shoes, excessively tight shoes, ski boots, and even cowboy boots all accelerate the bunion process. In addition, whether you wear shoes or not having low arches, flat feet, or hyper-mobility joints gives an increased risk of developing bunions.

 

ANATOMY AND BIOMECHANICS

From a biomechanical 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 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.


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 - This video uses orthopaedic test to evaluate for some of the most common ankle and foot conditions we see in clinical practice. These conditions include: 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.


Note: This video is available for the public on Jan 6/2023.

 

NON SURGICAL TREATMENT

The objective of non-surgical treatment is to prevent (or slow down) the progression of the bunion by correcting the biomechanical stresses on the foot, realigning the joint as much as possible, and by increasing the intrinsic strength of the foot.


Below are two videos demonstrating the type of treatment 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.


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).


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.


 

GENERAL RECOMMENDATIONS



Footwear

Shoes with narrow toes, and with higher heels can trigger/exacerbate a bunion. This is the reason why bunions are 10 times more common in women than men, women wear heels.


In most cases, bunion pain can be greatly reduced by wearing wider shoes, with a low heel and a softer sole. Make 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 bunion splints can provide short-term relief. Certainly, after bunion surgery, they can help when ligaments, tendons and soft tissues are healing. The highly recommend the soft toes spacers that can fit into your shoes. What bunion spacers don't do is correct the underlying problem.


Taping

Bunion taping can help reduce the pain and discomfort of a bunion 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, just be aware if you use ice too 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 and keep it in a more neutral position. This can reduce pain, and swelling, and slow down any arthritic changes in the joint.

 

EXERCISE

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: 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, and internal and external foot rotators using a Theraband.







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.





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


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 your appointment today!


 

DR. BRIAN ABELSON DC.

Dr. Abelson believes in running an Evidence-Based Practice (EBP). EBPs 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 is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publication which will be available later this year.


 


Make Your Appointment Today!

Make an appointment with our incredible team at Kinetic Health in NW Calgary, Alberta. Call Kinetic Health at 403-241-3772 to make an appointment today, or just click the MSR logo to right. We look forward to seeing you!





 

#buinons #foot #anatomy #biomechanics #treatment #MotionSpecificRelease #MSR #bunion #Calgary #Chiropractor #RoyalOak

3,431 views5 comments