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Bunion Battles: Douse the Flame of Foot Pain!

Updated: Feb 22

Are you familiar with Hallux Abducto Valgus? While the name may evoke images of enchanting spells, it's actually the scientific term for what many recognize as a bunion. This issue often manifests at the first metatarsophalangeal joint—the very foundation of your big toe. Derived from Latin, the word 'bunion' denotes 'enlargement,' indicating a distinct growth that commands attention. As for 'hallux abducto valgus (HAV)', it's a clinical description of how your big toe starts veering towards its adjacent toes. Intriguing, isn't it? For a more comprehensive understanding, refer to the accompanying illustration.

In the provided illustration, it's evident that the big toe leans towards its neighbouring toes, causing the bone behind it—the 1st metatarsophalangeal—to jut out prominently. This alignment places significant stress on the joint anchoring your big toe, leading over time to the distinctive curvature recognized as a bunion.


Initially, bunions represent inflamed tissue responding to external pressures, perhaps from the constriction of tight shoes. However, as the progression continues, this tissue becomes more pronounced, forming the characteristic bunion bulge.


Article Index


Introduction

Examination & Diagnosis

Treatment

Exercise

Diet

Conclusion & References

 

ANATOMY AND BIOMECHANICS

"The onset of a bunion initiates a cascade of biomechanical disturbances. When the 1st metatarsal bone, which supports the big toe, deviates outwards, it destabilizes the foot's inner arch, leading to its gradual collapse. Such an arch compromise exacerbates the growing bunion, accelerating its progress, further jeopardizing arch integrity. To effectively tackle this issue, addressing both the foot's instability and the misaligned joint becomes essential.


Beyond the strain caused by poorly fitting shoes, a walking style where the feet angle outwards can also play a role in bunion formation, especially due to the pressure on two specific muscles: the adductor hallucis and the abductor hallucis.


Assuming a unique 'number seven' shape, the adductor hallucis muscle spans from several lateral toes to the big toe. Upon its contraction, it pulls the big toe towards the adjacent second toe."

"The adductor hallucis muscle, when excessively tightened, can impede mobility, forcing the big toe into a consistent inward tilt towards the second toe, even without active muscle contraction. Such muscle tension commonly appears in individuals who frequently over-pronate or walk with their feet pointing outwards, a characteristic seen in many dancers and runners.


The persistent pull of the adductor hallucis muscle disturbs the essential balance of muscle tension, which normally ensures the straight alignment of the big toe. This harmony relies on the interaction between the adductor hallucis and the abductor hallucis muscles. The abductor hallucis muscle, which originates from the heel (calcaneus) and attaches to the big toe (proximal phalanx), typically offsets the force exerted by the adductor hallucis.


However, sustained pulling by the adductor hallucis can lead to the weakening and elongation of the abductor hallucis muscle. With the reduced opposition from the abductor hallucis, the big toe starts to lean inwards, thereby hastening the formation of a bunion."


Foot Anatomy (11 Muscles)


In this video, we review the anatomy of 11 muscles of your foot, primarily those on the plantar aspect.


 

Diagnosis


Foot Examination

In this video, we'll delve into the application of orthopaedic 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 typically the primary source of imaging for diagnosing bunions. It reveals bone alignment and the severity of the metatarsophalangeal (MTP) joint deformity. Standard foot views on the X-ray provide insights into hallux valgus angulation and any arthritic changes. While X-rays are foundational, in specific cases, MRI or Ultrasound might be employed to assess soft tissue concerns or co-existing pathologies. Accurate imaging equips clinicians to design a tailored treatment plan, ranging from conservative approaches to surgical interventions, catering to each patient's distinct requirements.


 


Surgery vs. Non-Surgical Interventions


Bunions can often be managed with conservative care aimed at symptom relief and slowing deformity progression. These methods effectively alleviate pain for many, enhancing mobility and daily functioning. However, while these treatments mitigate symptoms, they don't correct the bony deformity, leaving the root issue unaddressed. If the bunion's progression causes persistent pain or restricts activity, surgery might become an option.


For professional dancers, the prospect of surgery is approached cautiously due to possible complications, extended recovery, and potential dance performance impacts. They often lean more towards non-surgical methods.


While bunion surgery can provide relief, it's not a straightforward solution. Recovery might span six months, with follow-up doctor appointments possibly extending to a year. Post-operative outcomes may include limited shoe options or the inability to wear certain footwear.


If you are considering surgery thoroughly discuss the surgery with your physician, addressing benefits, risks, and post-op expectations. Note their insights for future reference. Fully comprehending bunion surgery's scope is crucial.


 

Non-Invasive Bunion Treatment


The main goal of non-surgical interventions is to address bunion progression. This involves mitigating biomechanical foot stress, attempting joint realignment, and bolstering foot strength.


We've included two videos below showcasing therapeutic approaches for bunion management. Remember, the techniques utilized will vary depending on individual cases, addressing joint mobility and tissue flexibility concerns.


Please note: The videos are purely illustrative. Procedures related to MSR should be undertaken exclusively under a certified professional's supervision."


Best Bunion Exercises and Nonsurgical Treatment:

In the video below, Dr. Brian Abelson guides us on addressing the entire kinetic chain to effectively alleviate bunions (Hallux Valgus). Meanwhile, Miki Burton RMT highlights important considerations for this condition and introduces a series of impactful bunion exercises. These specific exercises commence at the 09:35 timestamp in the video.


MSR - 7 Point Ankle & Foot Mobilization:

In the video, Dr. Abelson discusses joint mobility in the ankle and foot. Enhancing this mobility is crucial for effectively managing the body's kinetic chain. Neglecting joint mobility issues when addressing bunions can significantly limit the effectiveness of myofascial therapy. The goal of joint mobilization is to counteract unfavourable physiological changes by encouraging movement between capsular fibers.


 


Treatment Frequency Recommendations


When performing manual therapy for bunions, some patients may experience initial relief or improvement within the first few sessions, especially in terms of pain and flexibility. However, structural and functional changes, such as the realignment of the toe, can take longer and may require consistent therapy combined with exercises and possibly orthotic interventions. The exact timeline for results can vary based on the severity of the condition, patient adherence to home exercises, and individual differences in healing. Regular assessments and feedback are essential to gauge progress and adjust the treatment plan as needed.


Initial Treatment Phase:

  • MSR Manual Therapy: 2 sessions per week for two to three weeks.

  • Home Exercises: Daily functional exercise programs as prescribed by the MSR practitioner.


Response Assessment:

  • Evaluate the patient's response to therapy during follow-up appointments, typically after two to three weeks of treatment.


Positive Response:

  • A positive response to manual therapy for the treatment of bunions would be a noticeable reduction in pain and discomfort, coupled with improved toe alignment and enhanced functional mobility during walking and other activities.

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

  • Home Exercises: Continue daily routines; adjust as necessary based on professional advice.


Persistent Symptoms:

  • MSR Manual Therapy: Maintain frequency of two weekly sessions, reassessing the treatment approach weekly.

  • Home Exercises: Re-evaluate and modify exercises under professional guidance, ensuring correct technique and adherence.


When performing manual therapy for bunions, treatment should continue as long as there's an improvement in symptoms and function. If progress is noted and functional goals aren't yet met, ongoing therapy can be beneficial. If there are no noticeable results, only marginal improvements, or if progress plateaus, then treatment should be reconsidered or halted.


You should transition to maintenance care once the patient has achieved consistent symptom relief and optimal functional levels, ensuring that the achieved progress is sustained and potential recurrences are minimized. All decisions should be based on regular assessments and patient feedback.


Maintenance Phase:

  • MSR Manual Therapy: Monthly sessions or as needed.

  • Home Exercises: Daily routines to maintain benefits and prevent symptom recurrence, with periodic reviews by healthcare professionals.


 

General Recommendations


From choosing the right footwear to applying warm soaks and ice packs, these tips are geared towards alleviating the pain associated with bunions and enhancing your overall foot health. While some of these measures offer temporary relief, others can help slow down the progression of bunions over time. Let's delve into these recommendations for a more comprehensive understanding of managing bunions effectively.


Selecting Appropriate Footwear

Wearing shoes with tight toe boxes and high heels can exacerbate or initiate bunions. This footwear choice contributes to women's tenfold higher risk of bunions compared to men. To mitigate this, choose shoes that feature a low heel, a padded sole, and sufficient room for toe movement. The guiding principle should always be comfort before style.



Bunion Spacers: A Brief Reprieve

Toe spacers or bunion splints provide quick, interim relief, especially after bunion surgery when the ligaments, tendons, and soft tissues are healing. Choose soft spacers that comfortably fit inside your shoes. Remember, though, that these spacers offer temporary relief and don't tackle the underlying issue.


Taping Technique

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



Warm Epsom Salt Soaks

Indulging in warm soaks with Epsom salts, abundant in magnesium sulfate, 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, thereby diminishing the blood flow causing swelling and discomfort. However, use ice sparingly, as excessive application might impede healing by overly restricting blood flow. While both heat and cold can be beneficial, heat therapy is typically favored for chronic issues like bunions due to its ability to boost circulation, fostering healing and relaxation.


Tailored Orthotics

Custom orthotics are specialized insoles crafted to help curb bunion progression. They're designed specifically for your foot's unique structure, providing targeted support to address imbalances. Biomechanically, they realign the foot and regulate its mechanics during movement, crucially during the 'push-off' phase where the big toe endures significant weight.


Orthotics help keep the big toe neutral, reducing the lateral stress typically placed on the first metatarsophalangeal joint with bunions. This lessens the toe's inward shift, mitigating pain and managing swelling. By correcting foot mechanics, these orthotics also decelerate degenerative changes like arthritis in the joint. The outcome is not only reduced bunion symptoms but also enhanced foot function and comfort.


 

Exercise is Critical

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).


 

Diet and Bunions

A balanced diet can aid in bunion management by reducing inflammation and controlling weight, lessening joint stress. Consider these dietary pointers:


  • Omega-3 Fatty Acids: Found in fatty fish and flaxseeds, they reduce joint inflammation.

  • Omega-6 Balance: Common in processed foods, excess omega-6 can increase inflammation. Balance with omega-3 intake.

  • Antioxidants: Vitamins C and E, beta-carotene, and selenium combat oxidative stress, protecting joint cartilage.

  • Dietary Fiber: Foods like whole grains and vegetables nurture a healthy gut, reducing inflammation.

  • Protein: Sources like lean meat and fish support muscle strength, cushioning joints.

  • Watch Your Weight: A healthy weight lessens the load on joints. Limit processed foods and sugars to prevent weight gain.

  • Stay Hydrated: Water maintains cartilage hydration and joint lubrication.


 


Low-Impact Aerobic Exercise


Engaging in low-impact aerobic exercises like cycling or swimming is a potent tool for bunion management. Here's why:


  • Enhanced Circulation: Aerobic activities bolster capillary density, boosting nutrient delivery and waste removal, which aids recovery.

  • Anti-Inflammatory Effects: Exercises release anti-inflammatory agents like IL-6, IL-10, and IL-1ra, countering inflammation.

  • Suppressed Pro-Inflammatory Agents: Activities reduce pro-inflammatory molecules such as TNF-α and IL-1β.


Committing to about 150 minutes of aerobic exercise weekly can diminish inflammation, a well-founded approach to bunion care. Embrace the benefits and keep moving!


 

Conclusion


Bunions necessitate a tailored approach for adept management, with initial measures focusing on manual therapies like Motion Specific Release (MSR), exercises, and lifestyle tweaks such as appropriate footwear and dietary adjustments. These non-surgical interventions aim to ease discomfort and possibly decelerate the condition's progression.


While surgery is an available recourse, it's advisable as a last resort given its prolonged recovery timeline and lasting post-operative alterations. The ongoing advancements in science and medicine, inclusive of MSR techniques, furnish crucial insights and methods for non-surgically addressing bunions.


 

DR. BRIAN ABELSON DC. - The Author


Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.

 


Revolutionize Your Practice with Motion Specific Release (MSR)!


MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.


Attend our courses to equip yourself with innovative soft-tissue and osseous techniques that seamlessly integrate into your clinical practice and empower your patients by relieving their pain and restoring function. Our curriculum marries medical science with creative therapeutic approaches and provides a comprehensive understanding of musculoskeletal diagnosis and treatment methods.


Our system offers a blend of orthopedic and neurological assessments, myofascial interventions, osseous manipulations, acupressure techniques, kinetic chain explorations, and functional exercise plans.


With MSR, your practice will flourish, achieve remarkable clinical outcomes, and see patient referrals skyrocket. Step into the future of treatment with MSR courses and membership!

 

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


 

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