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A bunion (hallux valugus) occurs at the proximal joint of the big toe. Bunions are characterised by a bump formation on the inside of the foot, and the big toe angling towards the second toe. Bunions occur in 30% of the population in western countries, but only 3% in eastern countries. It is thought that bunions are mostly caused due to wearing tight fitting shoes and high heels. Individuals with flat feet and family history of bunions are also more susceptible.
The bump on the inside of the big toe is initially soft tissue swelling due to the irritated tissue being caught between the toe joint and the shoe. As the injury progresses, there may be extra boney growth and thickening. Which leads to a more prominent bunion and increased pain associated with this.
Treatment initially looks at the type of footwear the individual is wearing. You should replace heels and narrow shoes for flat cushioned shoes. These shoes should have a larger toe box.This provides increased space for the bunion, and therefore less pressure on the irritated tissue overlying the bunion. Your physiotherapist may also fit you with off the shelf or custom made orthotics, to reduce loading and pressure on the big toe joint.
To further manage inflammation and pain a variety of treatment options. Such as icing, deloading taping techniques and soft tissue massage may be useful. Following this, your physiotherapist will aim to restore optimal joint range of motion. Motion to the joints of the foot and ankle, which may be contributing to the formation of the bunion. Restoring optimal muscle length, in particular of the calf muscle is also important. It can be achieved through the use of soft tissue massage and dry needling. Your physiotherapist will also advise on activity modification, to allow pain and inflammation to settle.
In some cases, your physiotherapist may recommend you wear a bunion splint at night. This helps hold the joint of your big toe in the correct alignment as you sleep.
Besides on focusing on joints of the foot and ankle, your physiotherapist will also assess alignment and stability of your knees and hips.
Strengthening exercises prescribed by your physiotherapist will focus on not only strengthening the small muscles of the toes and foot. Also on improving pelvic, hip and knee stability. These exercises in combination with the above treatment techniques can all help in decreasing pain and inflammation, and preventing progression of the valgus deformity.