Self Help Series: Bunions
By: Anna Staehli Wiser, DPT, FAAOMPT
Hallux valgus, otherwise known as bunions, is a very common foot condition that causes malalignment at the base of the great toe and is usually accompanied by a fair amount of discomfort. This condition tends to affect middle aged women the most1.
What causes it? Hallux valgus is thought to be caused by wearing narrow shoes and also can be due to the type of foot structure we are born with. Shoes - and socks, push our toes together and inhibit the muscles in our toes from functioning properly. The abductor hallucis in particular, which is the muscle that splays the great toe away from the other toes, is essential for proper functioning of the entire foot. When this muscle becomes weak, it destabilizes the medial aspect of the forefoot and changes the angle at which we push off the foot during walking so that the great toe ends up getting pushed in a lateral direction2. Also, people who tend to have a flatter foot arch and restricted ankle mobility are more likely to develop bunions later in life1.
So what can be done about this? In the early stages, hallux valgus can be corrected. There are specific exercises3–5 that can be done to strengthen the muscles that splay the toes and hold up the foot arch. Strengthening exercises, stretching out the ankle, awareness of your posture and alignment, and changing your footwear can all have a positive influence in preventing bunions from getting worse and even correcting the bunion. Toe socks and toe spreaders can also be helpful in re-training your muscles3. Sneakers with arch support or foot orthotics6 will help keep your foot in a better alignment if you are going to be on your feet for long periods of time or exercising outdoors. In the house, going barefoot actually is the best way to strengthen your foot muscles. Taking opportunities to walk barefoot for short durations will allow the toes to splay apart and function how they should, especially if you have awareness of how to use your toe muscles properly with each step. Also, exercising barefoot can be very beneficial. Working on single leg balance activities, squats, and lunges while barefoot with the toes splayed apart is the best way to build up your intrinsic foot strength. Exercises that involve running and jumping are best done with supportive sneakers as the sneakers provide cushion and protection against bruising and bone stress.
Although strengthening and posture awareness are the key components to correcting bunions, hands-on therapy can help if there is pain associated with this condition. Deep tissue massage and joint manipulation will help to improve ankle joint and foot mobility and ensure proper mechanics when standing and walking. Dry needling has also been proven to be an effective treatment to reduce pain associated with hallux valgus7
If you are noticing bunions on your feet - even if they are not yet painful, now is the time to do something about it. This condition can be corrected in the earlier stages, so don’t wait until it is too late to fix it. Stop wearing those narrow shoes and make an appointment with physical therapy to learn how to strengthen your foot properly in order to prevent pain, disability, and unnecessary surgery down the road!
References:
1. Ray JJ, Friedmann AJ, Hanselman AE, et al. Hallux Valgus. Foot Ankle Orthop. 2019;4(2):247301141983850.
2. Oztarsu MB, Oksuz S. Comparison of the effects of progressive supervised and home program exercise therapy in mild–moderate hallux valgus. J Comp Eff Res. 2023;12(3). doi:10.2217/cer-2022-0091
3. Abdalbary SA. Foot mobilization and exercise program combined with toe separator improves outcomes in women with moderate hallux Valgus at 1-year follow-up. J Am Podiatr Med Assoc. 2018;108(6):478-486.
4. Bunion: Strengthening foot muscles to reduce pain and improve mobility. J Orthop Sports Phys Ther. 2016;46(7):606-606.
5. Hurn SE, Matthews BG, Munteanu SE, Menz HB. Effectiveness of nonsurgical interventions for hallux Valgus: A systematic review and meta‐analysis. Arthritis Care Res (Hoboken). 2022;74(10):1676-1688.
6. Li G, Shen J, Smith E, Patel C. The evaluation of orthotics in reducing hallux Valgus angle in patients with hallux Valgus over a twelve-month treatment. Int J Environ Res Public Health. 2022;19(19):12531.
7. Ying J, Xu Y, István B, Ren F. Adjusted Indirect and Mixed Comparisons of Conservative Treatments for Hallux Valgus: A Systematic Review and Network Meta-Analysis. Int J Environ Res Public Health. 2021;18(7). doi:10.3390/ijerph18073841
*Although joint manipulation is usually thought to be synonymous with chiropractic care, osteopractic physical therapists and osteopathic doctors are trained in spinal manipulation as well. Soft tissue massage is usually thought to be exclusively performed by massage therapists, but this is a technique that the osteopractic physical therapist is also well trained in. Lastly, dry needling is very similar to acupuncture in that both techniques employ the insertion of acupuncture needles and share the goal of promoting healing and reducing pain.
With osteopractic physical therapy, the patient gets a session that includes all the best treatments in one visit. So, if you are struggling with chronic pain, fear not - Dr. Wiser is here to help!
