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Bunion Battles: Douse the Flame of Foot Pain!

Ever heard of Hallux Abducto Valgus? It might sound like a spell taught at Hogwarts, but it’s the medical term for a bunion. This condition occurs at the base of your big toe, where the first metatarsophalangeal joint is located. The word ‘bunion’ comes from Latin, meaning 'enlargement,' perfectly describing the noticeable bump that forms as your big toe angles toward the other toes.


Bunion Graphic

As the big toe leans inward, the first metatarsophalangeal joint (where the big toe meets the foot) starts to protrude, placing stress on the joint and leading to the familiar bunion curve. Bunions begin as inflamed tissue caused by external pressures like tight shoes. Over time, this inflammation worsens, resulting in the characteristic bunion bulge.


Our Success Rate is Over Ninety Percent!

When we say our success rate in treating bunions is over 90%, we’re proud to share that this means over 90% of our patients experience a significant reduction in pain and a remarkable improvement in function. While we may not completely reverse bunions, our approach consistently delivers life-changing results, helping our patients walk more comfortably and enjoy their daily activities with greater ease.


Article Index


 

Anatomy & Biomechanics

Adductor Hallucis and Abductor Hallucis Graphic

The development of a bunion sets off a cascade of biomechanical problems, creating a frustrating cycle of discomfort and pain. As the 1st metatarsal bone shifts outward, it destabilizes the foot’s inner arch, leading to its gradual collapse. This instability doesn’t just worsen the bunion; it accelerates its progression, making every step more challenging. To truly overcome this issue, it’s essential to address the misaligned joint and the underlying foot instability.


Beyond the physical pressure from tight shoes, even your walking style can play a role. A gait where the feet angle outward places stress on two critical muscles: the adductor hallucis and the abductor hallucis.


The adductor hallucis, a muscle that forms a distinct ‘number seven’ shape, stretches from several lateral toes to the big toe. When it contracts, it pulls the big toe toward the second toe, further contributing to the development of a bunion—and adding to the frustration of dealing with this painful condition.


Sore Big Toe

When the adductor hallucis muscle becomes too tight, it can cause your big toe to tilt inward toward the second toe, even without the muscle actively contracting. This tension is common in people who over-pronate or walk with their feet turned outward, such as many dancers and runners.


This ongoing pull disrupts the natural balance between the muscles that keep your big toe straight. Typically, the adductor hallucis and the abductor hallucis muscles work together to maintain proper alignment. The abductor hallucis, which runs from the heel to the big toe, usually counters the force of the adductor hallucis.


But when the adductor hallucis remains tight for too long, it can weaken and stretch the abductor hallucis. With less resistance, the big toe gradually leans inward, speeding up the formation of a bunion.


 

Diagnosis


Foot Examination

In this video, we'll explore applying orthopedic assessments to diagnose prevalent foot and ankle ailments encountered in clinical practice. We'll discuss a range of conditions, including Ankle Sprains (focusing on inversion sprains), Cuboid Syndrome, Talar Dome Lesions, 5th Metatarsal Fractures, Syndesmosis injuries, Achilles Tendon Tendinopathy, Morton's Neuroma, 2nd Metatarsal Stress Fractures, Plantar Fasciitis, and the well-known Bunions.


Imaging

An X-ray is usually the first step in diagnosing bunions, providing a clear view of bone alignment and the extent of the metatarsophalangeal (MTP) joint deformity. Standard foot X-rays offer insights into the hallux valgus's angle (the big toe's inward tilt) and any arthritic changes. While X-rays are essential, MRI or Ultrasound may be used in specific cases to evaluate soft tissue issues or other related conditions. Accurate imaging helps clinicians create a personalized treatment plan, whether it involves conservative care or, in some cases, surgical intervention, ensuring the best outcome for each patient.



 


Dancer Jumping Doing a Leap on the Street

Surgery vs. Non-Surgical Interventions


Bunions are often managed with non-surgical treatments to relieve symptoms and slow the deformity's progression. These methods can effectively reduce pain, improve mobility, and enhance daily function for many people. However, while they help manage discomfort, they don’t correct the underlying bone deformity. If the bunion progresses to the point where it causes persistent pain or limits your activity, surgery might become necessary.


Professional dancers are particularly cautious about surgery due to the potential for complications, long recovery times, and the impact on their performance. They often opt for non-surgical approaches to maintain their activity levels.


Bunion surgery can provide significant relief but is not a quick fix. Recovery can take up to six months, with follow-up appointments possibly extending for a year. After surgery, you might face limitations in footwear choices or even the inability to wear certain shoes.


If you’re considering surgery, it's essential to discuss the benefits, risks, and recovery expectations with your physician. Please take note of their insights for future reference. Fully understanding what bunion surgery entails is crucial for making an informed decision.



 

Non-Invasive Bunion Treatment


The main goal of non-surgical bunion treatments is to slow their progression by reducing biomechanical stress on the foot, realigning the joint, and strengthening the surrounding muscles.


Below, you'll find two videos demonstrating therapeutic techniques for managing bunions. These approaches focus on improving joint mobility and tissue flexibility, and may be adapted based on individual needs.


Please remember: These videos are for illustration only. MSR procedures should always be performed under the guidance of a certified professional.


Best Bunion Exercises and Nonsurgical Treatment:

In the video below, Dr. Brian Abelson walks you through addressing the entire kinetic chain to relieve bunions (Hallux Valgus) effectively. Miki Burton, RMT, also shares key insights into managing this condition and introduces a series of effective bunion exercises. You can jump to these exercises at the 09:35 mark in the video.


MSR - 7 Point Ankle & Foot Mobilization:

In this video, Dr. Abelson explores the importance of joint mobility in the ankle and foot, which is essential for managing bunions (Hallux Valgus) effectively. Enhancing joint mobility is key to addressing the body's entire kinetic chain. Overlooking these mobility issues can limit the success of myofascial therapy in treating bunions. Joint mobilization helps counteract negative physiological changes by promoting movement within the joint's capsular fibres.


Facial Expansion: MSR Foot Pain Protocol

Treating bunions with fascial expansions provides a holistic approach that combines a modern understanding of fascia, kinetic chain dynamics, and principles from acupuncture and traditional Chinese medicine. This method connects fascial lines with specific acupuncture points like ST44, LV3, LV2, K3, and B60, creating a comprehensive treatment plan. By addressing the altered biomechanics and inflammation linked to bunions, this strategy helps reduce pain, improve tissue mobility, and manage scar tissue. It also restores proper foot alignment and function, easing discomfort and preventing further bunions-related complications.



 


Treatment Frequency For Bunions


Manual therapy for bunions can provide initial relief within the first few sessions, but achieving lasting structural changes like toe realignment requires consistent treatment. The timeline varies based on the severity of the condition, adherence to home exercises, and individual healing.


Initial Treatment Phase:

  • MSR Manual Therapy: 2 sessions per week for 2-3 weeks (or one 30-minute session per week).

  • Home Exercises: Daily exercises as prescribed.

  • Assessment: Evaluate progress after 2-3 weeks.


Assessment Response - Positive

  • MSR Manual Therapy: Reduce to 1 session per week.

  • Home Exercises: Continue daily, with adjustments as needed.

Assessment Reponse - Negative or Persistant

  • MSR Manual Therapy: Maintain 2 sessions per week, reassessing weekly.

  • Home Exercises: Re-evaluate and adjust under professional guidance.


Continue treatment as long as symptoms and function improve. Transition to maintenance care once consistent relief and optimal function are achieved.


Maintenance Phase:

  • MSR Manual Therapy: Monthly sessions or as needed.

  • Home Exercises: Continue daily to maintain benefits, with periodic professional reviews.



 

General Recommendations


From selecting the right footwear to using warm soaks and ice packs, these tips are designed to ease bunion pain and improve your overall foot health. While some provide immediate relief, others can help slow the progression of bunions over time. Let’s explore these recommendations to better manage your bunions and keep your feet feeling their best.


Foot Wear Image

Selecting Appropriate Footwear

Tight toe boxes and high heels can worsen or even cause bunions, so women are ten times more likely to develop them than men. To prevent this, opt for shoes with a low heel, cushioned sole, and plenty of room for your toes to move. Remember, comfort should always come before style.



Bunion Spacers: A Brief Reprieve

Toe spacers or bunion splints can provide short-term comfort, particularly after bunion surgery when your ligaments, tendons, and soft tissues are healing. Opt for soft spacers that fit comfortably in your shoes. Keep in mind that while they offer temporary relief, they don't address the root cause of the problem.


Taping Technique

Using bunion tape can ease pain by correctly aligning the joint and lessening bunion pressure. This method realigns the big toe, removing the strain from the first metatarsal joint. For a demonstration, please refer to the video on the right.




Epsom Salt Soak Image

Warm Epsom Salt Soaks

Indulging in warm soaks with Epsom salts, abundant in magnesium sulphate, offers a comforting relief from bunion discomfort. This age-old mineral is lauded for its therapeutic qualities, notably pain alleviation. Immersing your feet in a warm Epsom salt solution for 10 to 20 minutes lets your skin absorb the minerals, aiding in muscle relaxation and inflammation reduction."


Considering Ice Packs

If warm soaks aren't providing adequate relief, consider trying ice packs. Applying cold packs for 10 to 15 minutes can lessen inflammation by narrowing blood vessels, diminishing blood flow, and causing swelling and discomfort. However, use ice sparingly, as excessive application might impede healing by overly restricting blood flow. While heat and cold can be beneficial, heat therapy is typically favored for chronic issues like bunions because it boosts circulation, fostering healing and relaxation.


Runner on Stairs

Custom Fitted Orthotics

Custom orthotics are specialized insoles designed to slow the progression of bunions. Tailored to your foot's unique structure, they provide targeted support to correct imbalances. Biomechanically, orthotics realign your foot and regulate movement, especially during the 'push-off' phase when the big toe bears significant weight.


By keeping the big toe in a neutral position, orthotics reduce the lateral stress on the first metatarsophalangeal joint, easing pain and managing swelling. They also help slow degenerative changes like arthritis, improving foot function and comfort while reducing bunion symptoms.


 

Exercise is Critical

Here are some example exercises we might recommend for patients with bunions. Keep in mind, this is just a sample; the specific exercise routine will be tailored to each individual’s needs.


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).



Additional Foot and Toe Strengthening Exercises

In addition to our regular strengthening routine, incorporating these extra exercises can significantly improve results, especially when addressing bunions. Strengthening your ankles, feet, and toes is not only vital for bunion correction but also plays a key role in preventing injuries and boosting sports performance. By adding these exercises, you’ll further enhance balance, stability, and mobility, ensuring a solid foundation for healthier feet and better overall function.



 

Diet and Bunions

Salmon & Vegetables on Plate

A balanced diet plays a crucial role in managing bunions by reducing inflammation and minimizing joint stress. Here’s how specific nutrients can help:


  • Omega-3 Fatty Acids: Present in fatty fish and flaxseeds, omega-3s are known to reduce joint inflammation, helping to alleviate bunion discomfort.

  • Omega-6 to Omega-3 Balance: While omega-6 fatty acids, common in processed foods, can increase inflammation, maintaining a healthy balance with omega-3 intake is vital to control inflammation levels.

  • Antioxidants: Nutrients like vitamins C and E, beta-carotene, and selenium combat oxidative stress, protecting joint cartilage from damage.

  • Dietary Fiber: Foods high in fiber, such as whole grains and vegetables, support a healthy gut microbiome, which plays a role in reducing systemic inflammation.

  • Protein: Lean meats, fish, and plant-based proteins help maintain muscle strength, providing better support for joints and reducing strain on the metatarsophalangeal joint.

  • Weight Management: Maintaining a healthy weight reduces the mechanical load on your joints, crucial for preventing further bunion progression. Limiting processed foods and sugars helps avoid unnecessary weight gain.

  • Hydration: Adequate water intake keeps cartilage hydrated and joints lubricated, essential for maintaining joint function and reducing friction in the metatarsophalangeal joint.



 


Person Swimming

Low-Impact Aerobic Exercise


Incorporating low-impact aerobic exercises like cycling or swimming can be a powerful strategy for managing bunions. Here’s why:


  • Enhanced Circulation: These activities increase capillary density, improving nutrient delivery and waste removal, which supports recovery.

  • Anti-Inflammatory Benefits: Exercise releases anti-inflammatory agents such as IL-6, IL-10, and IL-1ra, helping to reduce inflammation.

  • Reduction of Pro-Inflammatory Molecules: Regular aerobic activity decreases levels of pro-inflammatory molecules like TNF-α and IL-1β.


Committing to about 150 minutes of aerobic exercise each week can significantly reduce inflammation, making it a smart approach to bunion care. Embrace the benefits and keep moving!


 

Why Choose Our Approach for Bunion Relief


With a success rate of over 90%, our bunion treatment significantly reduces pain and improves function for most patients. While we may not fully reverse bunions, our approach consistently delivers life-changing results, allowing you to walk more comfortably and enjoy daily activities with greater ease.


Here’s why our method stands out:


  • Established Expertise: Developed by Dr. Brian Abelson, the MSR methodology is supported by over 30 years of clinical experience and the successful treatment of more than 25,000 patients, ensuring top-quality care for your bunions.

  • Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including joint misalignment, biomechanical imbalances, and muscle tension, which are often present with bunions.

  • Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques precisely target fascial restriction and joint misalignment areas, providing effective and focused relief.

  • Customized Exercise Programs: We create personalized exercise plans to enhance tissue mobility, strengthen the foot and ankle muscles, and restore proper alignment, supporting your recovery.

  • Logical, Evidence-Based Approach: Our treatment protocols combine manual therapy, exercises, and supportive measures to offer a comprehensive and lasting solution. We set clear timelines and regularly re-evaluate to track progress and adjust the treatment plan as needed.


Choose our proven, patient-centred approach for effective, long-term relief from bunions. With confidence, take the first step toward comfort and improved mobility.



 

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.

  6. 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.

  7. Menz, H. B., & Morris, M. E. (2005). Footwear characteristics and foot problems in older people. Gerontology, 51(5), 346-351.

  8. 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.

  9. 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.

  10. 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.

  11. Dufour, A. B., Casey, V. A., Golightly, Y. M., and Hannan, M. T. (2014). Characteristics associated with hallux valgus in a population-based foot study of older adults. Arthr. Care Res. 66, 1880–1886. doi: 10.1002/acr.22391

  12. Groarke, P., Galvin, R., Kelly, J., and Stephens, M. M. (2012). Quality of life in individuals with chronic foot conditions: a cross sectional observational study. Foot 22, 66–69. doi: 10.1016/j.foot.2011.11.007

  13. Klein, C., Groll-Knapp, E., Kundi, M., and Kinz, W. (2009). Increased hallux angle in children and its association with insufficient length of footwear: a community based cross-sectional study. BMC Musculoskelet. Disord. 10:159. doi: 10.1186/1471-2474-10-159

  14. Zech, A., Meining, S., Hotting, K., Liebl, D., Mattes, K., and Hollander, K. (2018). Effects of barefoot and footwear conditions on learning of a dynamic balance task: a randomized controlled study. Eur J Appl Physiol. 118, 2699–2706. doi: 10.1007/s00421-018-3997-6


 

Disclaimer:

The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.


This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.


By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies in this website.



 

DR. BRIAN ABELSON, DC. - The Author


Photo of Dr. Brian Abelson

With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.


As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.


A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.



 


MSR Instructor Mike Burton Smiling

Why Choose Our MSR Courses and MSR Pro Services?


Elevate your clinical practice with our Motion-Specific Release (MSR) courses and MSR Pro services, designed to provide a comprehensive, evidence-based approach to musculoskeletal care. Here’s why you should join us:


  • Proven Methodology: Developed by Dr. Brian Abelson, an international best-selling author with over 30 years of clinical experience, MSR integrates the most effective elements of osseous and myofascial therapies. With a success rate exceeding 90%, our approach helps set a new industry standard.

  • Comprehensive Training: Our courses blend rigorous academic content with innovative techniques. You’ll master essential areas like orthopedic and neurological examinations, myofascial treatment, fascial expansions, and osseous adjusting and mobilization.

  • Extensive Resources: As an MSR Pro subscriber, access a vast library of over 200 MSR procedures, fillable PDF forms, instructional videos, and in-depth articles. From patient intake to tailored exercise prescriptions, our resources equip you for clinical success.

  • Tailored Support: Refine your diagnostic skills and expand your treatment techniques with ongoing support through over 750 videos, including 200 technique videos, 250 exercise videos, and 160 MSK articles. This extensive library features over 50 musculoskeletal condition articles, all designed to support you in clinical practice. Our resources are dynamic, with regular updates to articles, technique videos, and new additions to our educational curriculum.

  • Innovation and Growth: We emphasize continuous learning and innovation, giving you the tools to adapt and thrive in complex clinical scenarios. Our courses and resources are designed to foster professional growth, keeping you at the forefront of musculoskeletal therapy.


Unlock your practice's full potential with our MSR courses and MSR Pro services. Achieve outstanding clinical outcomes and join a community of forward-thinking practitioners dedicated to excellence in patient care.



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