Article by John Miller
What is a Bunion?
A bunion is a deformity of the big toe. A bunion is a toe that points at a sideways angle towards your second toe. There is also a characteristic bump on the inner side of the foot.
As the bunion becomes more prominent, bunion pain can develop. The medical term for a foot bunion is hallux valgus.
What Causes a Bunion?
Bunions are a result of complex biomechanical changes that occur in your feet.
The type of footwear that you wear does cause bunions. We know that foot bunions occur in about 30% of the population of most Western countries but only 3% in Eastern countries. They are seen most commonly in women and become more common as people get older.
Tight-fitting shoes are thought to be the main cause of bunions.. Shoes such as high heels and shoes with tight toe boxes (eg womens fashion shoes and cowboy boots) are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box.
The slope causes the front of the foot to bear your weight, which encourages your forefoot to widen. Also, the angle pushes your toes into the narrow toe box, causing the toes to become angled and squeezed together.
With prolonged wearing of constraining footwear your toes will adapt to the new position and lead to the deformity we know as a foot bunion.
Footwear is not the only cause of a bunion. Injuries to the foot can also be a factor in developing a bunion. Poor foot arch control leading to flat feet or foot overpronation does make you biomechanically susceptible to foot bunions.
A family history of bunions also increases your likelihood of developing bunions.
Many people who have a bunion have a combination of factors that makes them susceptible to having this condition.
For example, if you are a women over the age of forty with a family history of bunions, and often wear high-heeled shoes, you would be considered highly likely to develop a bunion.
PHASE I - Pain Relief. Minimise Swelling & Injury Protection
Pain is the main reason that you seek treatment for bunion. Analgesics may help.
Inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Anti-inflammatory medications may help.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation.
These include: ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and orthotics to off-load the bunion.
PHASE II - Restoring Normal ROM & Posture
As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal toe and foot joint range of motion and muscle length.
Treatment may include joint mobilisation and alignment techniques, massage, muscle and joint stretches, taping, a bunion splint or orthotic.
Your physiotherapist is an expert in the techniques that will work best for you.
PHASE III - Restore Normal Muscle Control & Strength
Your foot posture muscles are vital to correct the biomechanics that causing your bunion to deteriorate. Your physiotherapist will assess your foot posture muscles and prescribe the best exercises for you specific to your needs.
PhysioWorks has developed a Foot Posture Correction Program to assist you to regain your normal foot posture.
Please ask your physio for their advice.
PHASE IV - Restoring Full Function
During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their feet that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity.
Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals.
PHASE V - Preventing a Recurrence
Bunions will deform further with no attention. Plus, the bunion pain associated does have a tendency to return. The main reason is biomechanical.
In addition to your muscle control, your physiotherapist will assess your foot biomechanics and may recommend either a temporary off-the shelf orthotic or refer you to a podiatrist for custom made orthotics. You should avoid wearing high heel shoes and shoes with tight or angular toe boxes.
Your physiotherapist will guide you.
Bunion surgery is occasionally required when the bunion deformity is too advanced for conservative treatment to work. Your surgeon will usually cut an angular section from the bone to correct the alignment. In some cases, multiple toes may need to be straighten.
Bunion Night Splints
Bunion Night Splints are an option for stretching and re-aligning your toe joint.
The most popular bunion splints that we recommend are:
More Bunion Advice
If you have any concerns or have some specific questions regarding your condition, please ask your physiotherapist.
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