How to Conservatively Treat Bunions
Dr Rich Blake
And, let us say you have bunion pain. Pain can definitely bring you to the doctor for treatment, and surgery has to be in the back or front of your mind. But, is it bunion pain? It could be something else. It is best to get your bunions professionally checked. Patients can with conservative treatment, delay the need for surgery and sometimes prevent it.
So, you decide you have a bunion. Your mom and/or grand mom did, so it is in the genes. What to do? There are many conservative treatments that I will try to summarize in this handout. Typically if you consistently do three or four of these self care treatments, your bunions will be much less painful. You want to avoid getting to Stage 4 Bunion Development as shown in the photo below. Stage 4 is always a surgical problem because of how it negatively effects the rest of your foot and your walking gait.
Stage 4 Bunion
1. Toe Separators
Standard Medium Gel Toe Separators that can be purchased from Silipos.
Toe Separators can be bought made of gel, foam and rubber. This image shows gel one that attaches to the second toe for more stability. Avoid the toe separator that attaches the first and second toes together since it would make the first and second toes move together whereas they normally move separately.
2. Night Splints
3. BUDIN SPLINT
4. YOGA TOES
You do not walk around with these as it could be dangerous. If you have trouble fitting between all your toes, cut out the partitions between some. It is the separation of the first and second toes that we are looking for. Also running the yoga toes under water can help lubricate the rubber to allow them to slip on your toes easier.
5. STRENGTHEN INTRINSIC FOOT MUSCLES FOCUSING ON ABDUCTOR HALLUCIS
Metatarsal Doming is the best exercise to begin strengthening the small muscles in your foot. While doing these exercises focus on moving the big toe downward and away from the second toe. The Abductor Hallucis pulls the big toe away from the second. Some patients have great difficulty separating the first and second toes and must use toe separators, Theraband, or bunion taping to place the big toe away from the second toe in order to start the exercise in the correct position.
7. Injinji SOCKS or Vibram FiveFinger Shoes
8. Bunion Protection
Use ¼” adhesive felt from www.mooremedical.com just behind the bunion towards the arch, not over the bunion. This has probably given my patients the most pleasure since it greatly increases the amount of fashionable shoes they can wear. Therefore, I would put this as the third most important conservative treatment step for bunion care.
9. Ice massage
If your bunion is red, even if it is not painful, you have some low level inflammatory tissue at the bunion prominence. This makes the bunion more fragile and more likely to get irritated with various shoes. Introducing daily 5 minute ice massage by melting an ice cube over the bunion should be done until the skin over the bunion looks normal on a consistent basis. You can speed up the process by ice massaging two or three times per day. You can substitute good hydrating cream or lotion for the massage when the bunion is not painful.
Cyrocup which can be purchased online, is used here to reduce inflammation around the bunion. Ice cube in a cloth towel works well.
10. Biomechanical changes
If you pronate and your bunion hurts with certain shoes, experiment with Hapads or other OTC arch supports like Sole to see if you get pain relief. You can use custom orthotics if the force of pronation is too great to control with OTC devices. However, treating bunions with any insert is always a delicate balance between support and shoe crowding.
Other biomechanical changes would be selecting shoes that are stable and with a wide enough toe box to accommodate the bunion. You do not want to wear too loose of a shoe as it leads to instability and other problems. Make sure you feel stable in any shoe your select. Make sure when you are selecting shoes that you feel that you rolled through the center of your foot and not through the big toe joint at push off.
11. Shoes with Good toe box Width
13. HIGH HEELS