Bunions, the bain of many peoples lives. But why do we get them and what can we do about them?
The word bunion literally means “enlargement” which is very apt in this case.Bunions, or to give it it’s clinical name Hallux Valgus are caused when the first metatarsal of the hallux moves in a lateral direction, and the first phalanx moves medially. So what causes this?
Well there are many thoughts about it, but the consensus seems to be that as the foot arches weaken and the foot pronates, the first metatarsal is exerted to undue pressure. As a consequence of this it is thought to affect the ligament that keeps the toes straight. As a result, we get the big toe twisting laterally.
So what can we do about bunions?
Well this started due to the foot becoming weak, so a good place to start in rectifying it, would be to strengthen the arches of the foot. Both the longitudinal and transverse arches have been found to be weak in people with bunions, so exercises such as towel scrunches and picking up items with the foot are a good starter exercise.
Other exercises for supporting the arch may again help, so heel raises work, well as they strengthen the Tibialis Posterior muscle, which helps to support the longitudinal arch. One foot balance exercises will get the small muscles of the foot working and this can progress onto balancing on the stability disc.
A good rule of thumb is that if there is passive movement available at the joint, then we can probably go some way to alleviating and realigning the joint. Bunion toe separators work well, it is worth getting clients to wear them while doing the foot strengthening exercises, that way they are strengthening the joint in a more functional position. We don’t want to strengthen the joint in an incorrect position as that will just support the incorrect alignment. Use the passive range they have and strengthen with the toes as straight as possible, over time that passive range may increase, but if it doesn’t at least they have some strength to support the incorrect position.
Other treatment options.
An arch support may also be an initial option as it will help to realign the foot and offload the joint which may, at least, stop it getting worse. This is however, only a temporary solution as long term wearing of arch supports may weaken the arch further. Icing and soft tissue work may help to break down the scar tissue and therefore assist with the specific pain many feel at the joint itself.
So, in conclusion, bunions are hard to rectify, but that shouldn’t stop us trying. The longer the client has had the bunion the harder it will be to get any change to the toe position, so if you see this developing in your client, jump on it early! Use all the tools available, so strength the foot, use soft tissue work and icing and even arch supports initially if you need to. It will take time and you are unlikely to fully realign the joint but improvements can be made and this will improve the biomechanics all the way up the chain.
If using this for CPD:
1. Remind yourself of the bones, muscles and ligaments of the foot. Which bones form the foot arches and how are they supported?
2. Then take a think of a gym or clinic training program that can improve the foot strength for your client. Don’t ignore the lower leg muscles, or in fact the whole chain up the lower body.
3. What other problems may occur in a client who has bunions, and therefore weak feet? Think up the chain…..
Then write it all up in your CPD log, for your ,free CPD logbook sign up to our newsletter here.
Reinge Education provide CPD courses for therapists and trainers across the country, these are in both an online format and in face to face workshops. Our unique combination of knowledge allows us to provide a fresh approach, looking at how anatomy affects function within the body, merging therapy and sports science to give a unique perspective.
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