Welcome to our second month of Movement Mondays and the “Bunion Blog!” with Dr. Jewell
I have had a flurry of discussion on bunions, toe surgery and foot pain lately so thought I would take this time to address an issue that has people getting out their punch card for the podiatric surgery ward. I have so many patients telling me that their bunions are “just genetic” or they don’t know how to undo the damage it’s caused.
Cue the trumpets! We are here to help!
There are generally 2 ways a bunion can form, from improper loading of your first Metatarsal Phalangeal Joint aka MTP Joint, or the lateral displacement of the big toe, aka Hallux Valgus. This sounds like a lot of medical jargon so let’s break those terms down.
The MTP Joint is that area that makes up the ball of the foot, think of it as the knuckle of your big toe. With every step you take you at one point put a significant amount of body weight and force on this joint. Now think of a foot that has a flat arch or is put into a fashionable high heel shoe and double or even triple the force put onto this relatively small joint. This increase in force sends signals to the body to increase bone density by creating a bone spur to support this bigger force. Ta-da! Bunion!
The other possible cause, Hallux Valgus, is basically when the big toe starts to point and curve over towards the little toes. Now imagine, not only how uncomfortable this is to walk on, but how much torque and pressure this puts on the medial border of that MTP joint. The most common culprits of this toe drift is improper gait patterns and footwear. Oh, how we suffer for fashion! Below is a picture showing what our natural toe space looks like over an average (narrow) toe box. Can you see the problem here? The natural amount of space the front of our foot and toes take up is greater than the area in the front of our shoes. Naturally we squeeze our toes into this shoe, pushing our big toe in towards our other toes and again we see, instant bunion maker!
I know what you’re thinking: “I can’t throw all my shoes out and roam the streets barefoot! This is a cold and damp climate we live in!” This is true, and unfortunately it is very difficult (and usually unfashionable) to find such shoes that allow the space we need. So instead let’s look at what we can do to undo this damage. The easiest starting point is to start with toe stretches, this can be as low tech as using your fingers to stretch the space between your toes (see photo below) or as high tech as wearing toe spreaders to bed at night and stretch while you sleep! (I would recommend not wearing these while weight-bearing and possibly even slowly introducing them by wearing them for a few hours each night and slowly working your way up to the whole night.)
There are also strengthening exercises we can do for the intrinsic muscles of the foot, don’t worry no gym gear required. With your feet flat on the floor try lifting your big toe up off the floor while keeping your little toes flat on the ground. Can you do it? About 50% of people find this impossible, if you’re one of them keep practicing and you will build up the muscle strength to do this no problem!