As we post more information and exercises for the feet, we are commonly asked about bunions. Those who have bunions are very familiar with what they are. For those who do not have bunions, a bunion is a bony formation on the medial side at the base of the big toe (the metatarsophalangeal joint, or MTP). This bump is caused due to the big toe being pushed in toward the other toes, sometimes so far that it actually will sit on top of the next toe in. Some individuals also form a Tailor’s bunion, which is along the lateral side of the little toe. For this discussion, we are going to focus on bunions at the first MTP joint.

So what causes bunions? Some people feel they are hereditary, but there are many other things that can contribute to the formation of bunions (and even if bunions do “run in your family” - these other factors are likely making them worse). One of the most common causes of bunion formation is the type of shoes we wear. Many shoes have a narrow toe box, especially high heeled shoes, which causes the toes to be pushed together. Another possible cause of bunions is faulty walking patterns, which are typically caused due to weakness of the feet or hips (or other musculoskeletal problems). Once bunions have formed, they can also alter gait mechanics as well.

Due to the alterations in alignment of the first MTP joint, walking on a bunion can become very painful. This is typically when individuals seek treatment for bunions. Yes, there are surgical options to correct bunions, however as with any other musculoskeletal problem, surgery should be a last resort when possible. One study showed that bunion operations fail in 1 in 6 individuals each year. There is certainly a time and place for surgery, however I would always encourage anyone with a painful bunion to try conservative management first. If an individual does need to undergo bunion surgery, I cannot emphasize enough the importance of a rehabilitation program with a focus on building foot strength and education on proper footwear.

So what does conservative management of a bunion look like? It is a process. First, building strength and improving mobility of the first toe is probably the most important step. We have been sharing foot exercises on our instagram pages - so if you aren’t sure where to start, that’s a great place! The next step is addressing other musculoskeletal imbalances that could be contributing to an abnormal gait pattern, which could also be contributing to your bunion (this is where the individualized assessment becomes important!). Finally, change your footwear. Look for shoes with a wide toe box, avoid heels, and as your feet become stronger, gradually move toward more functional footwear.

Have you been suffering from a painful bunion? Interested in seeking treatment to improve your foot health and get back to pain free activity? Contact us at info@absolutekineticspt.com.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS