Treatment Options for Bunions
What is a bunion?
A bunion (hallux valgus) is a bony bump that forms on the inside of the great toe joint. It forms when the first metatarsal (or foot bone) moves medially and the first phalange (or great toe) moves laterally causing a bump at the metatarsophalangeal (MTP) joint. The bump on the inside of the first digit can become calloused, red, sore and painful, develop arthritic changes, limit great toe and foot mobility, cause other foot problems and changes in gait and make it difficult to wear certain footwear. Tailor’s bunions (or bunionettes) can form on the pinky toe side of the foot but they are less common. It is estimated that ⅓ of people have bunions. Bunions are classified as mild, moderate or severe based on radiologic images and measuring the angles between the bones. Pain levels and overall function of the foot should guide treatment strategies.
What causes bunions?
There are probably numerous factors that cause bunions. Intrinsic factors include genetics, sex (females>males), ligamentous laxity, other foot deformities, neuromuscular disorders (like stroke or cerebral palsy) or inflammatory conditions (such as lupus or rheumatoid arthritis). Extrinsic factors may include footwear choice (especially high heels or narrow shoes), excessive weight bearing, athletic injuries and deficits in postural and gait mechanics.
Will bunions go away?
No, but physical therapy may help with the pain, improve the range of motion, strength and mechanics of your foot and lower extremity and prevent bunions from getting worse. Surgery should be the last resort after physical therapy and all conservative measures have been exhausted.
What can be done to treat bunions?
Improve your toe splay with manual stretches and soft tissue mobilization
Use toe spreaders and toe socks
Use bunion pads or cushions to decrease pain
Get orthotics to support the foot if recommended by your PT or doctor
Choose better footwear with wide toe boxes. Do not wear heels that put extra pressure on the great toe joint
Improve foot, ankle and toe range of motion
Increase strength in your arch, foot intrinsics (think toe yoga), ABductor hallucis (the muscle on the side of your great toe and arch that will pull your great toe back to midline) and ankle musculature. Often there is weakness further up the chain into the pelvis and hip that needs to be addressed as well
Improve overall posture and gait mechanics
Manage pain and swelling with ice and anti-inflammatory medications if ok with your doctor. Sometimes corticosteroid or stem cell injections may help
What are some physical therapy considerations if there are bilateral bunions compared to unilateral bunions?
Bilateral bunions - Proximally look at poor/paradoxical breathing patterns and/or there could be an anterior pelvic tilt, tight hip flexors and pelvic floor weakness. Distally address intrinsic foot weakness, rear foot overpronation, hypermobility, ligament laxity and posterior tibialis strength.
Unilateral bunions - Often the legs are doing something different, there may be a functional leg length discrepancy and/or one foot is often more supinated and the other more pronated. Proximally look at breathing patterns (one side may be more inhibited than the other) and there may be poor hip extension with delayed glut activation. Be sure to look for structural instabilities further up the chain like femoral or tibial torsions and valgus or varus forces. Distally there may be similar issues as with bilateral bunions or there may have been an injury/trauma to one foot, such as ankle sprains, fractures, spring ligament tears, etc.
Bunions can be very manageable if you start early and learn what can be done to prevent the bunions from getting worse over time. They do not have to be painful and there are conservative ways to manage symptoms. Most people will benefit from using toe spreaders/toe socks, wearing footwear with wider toe boxes that mimic the natural shape of the foot and improving range of motion, strength and mechanics of the foot and lower extremity. Prevention is always the best medicine. See your physical therapist early!
