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Saturday, June 28, 2014

How to Conservatively Treat Bunions



                     How to Conservatively Treat Bunions

                                     Dr Rich Blake

 

      Bunions are normal bones in abnormal positions. The process of developing bunions is very slow, but some activities can speed up the formation. Shoes are blamed excessively, but are rarely the underlying cause.  Managing and slowing down the development of bunions can prove very helpful to some people. 

      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 
You have bunions and you want to avoid surgery for as long as possible, here are your common treatments.

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.

     Medium gel toe separators for weight bearing with shoes is probably the most single important aspect of conservative treatment for bunions.  It is to be worn any time you are weight bearing to negate the gentle consistent push of the shoes on big toe towards the second toe. 







2.    Night Splints

     This night splint can be purchased from Footsmart.com and it is the best one I have seen.  You should wear a sock over it so that the Velcro does not catch on your bedding.  Over 50% of my patient feel that this is helpful when they first start their bunion care while they get use to some of the other treatments below.  Slowly it will have less effect as you loosen up the tissue between the first and second toes. 


3.    BUDIN SPLINT



     If the bunion is accompanied by a 2nd hammertoe as in the Stage 4 bunion above, use a Budin Splint (also known as Single Loop Hammertoe Regulator) to get the 2nd toe down.  You can also use Kinesiotape, Rocktape, or 3MNexcare Waterproof tape to hold down the 2nd toe. 



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. 

     Yoga toes are the second most important conservative treatment for bunions.  They are to be worn 30 minutes per day and not to be walked on or slept with. They produce a gentle stretch on the soft tissues to help pull the toes into  better position.  Many of my patients use the knock offs from Bed Bath and Beyond or Walgreens, called Healthy Toes or Pampered Toes. 



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.

6.     Bunion Taping
     Bunion taping placed daily can help train the toes to go in the right direction (or at least a better direction).  If your bunion is large (Stage 3 or 4 normally), consider a 3 month trial of bunion taping with Kinesiotape, Rocktape or 3M Nexcare  Waterproof Tape.








7.    Injinji SOCKS or Vibram FiveFinger Shoes



     Socks or shoes with individual compartments can be worn around the house or for short errands to strengthen your toes in the correct position. 



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.

I  also love massage oils or combinations of Aloe Vera and Vitamin E. 

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



Here Dr Jane Denton, my partner for 31 years, goes through great lengths analyzing the proper fit of shoes.
     Select shoes that do not put too much pressure on the bunion area.

12.   SHOE SOFTENING

    If there are slight pressure problems in some of your shoes that are not relieved with the felt padding, try to have local shoe repair store stretch them.  They need to take them overnight to do a proper job. 



This photo just demonstrates the fact that a shoe repair store can soften the leather in any spot like for a bunion. Many of my patients buy their own ball and ring stretchers and leather softening spray to do this themselves.

 13.  HIGH HEELS



Most podiatrists feel that heels over 2 inches place too much pressure on the ball of the foot increasing the chance for bunions. If the above conservative treatments are used, and you use some common sense in terms of the fit, you should be able to wear sensible heels and not have problems

23 comments:

  1. Bunion surgery is never a "have-to" thing. Often if you wear shoes that do not press on the bump on the inside of the big toe, it will be tolerable. Shoe stretchers can help keep the shoes loose and choosing shoes that will expand and conform to your foot shape can help.
    http://www.footcentersofnc.com/common-foot-problems/bunions.html

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  2. I hAVE a bunion on the same foot as the ankle I had surgery on and it causes a lot of pain should I consider surgery

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  3. I am really impressed with your post and the way you have explained the topic of bunion treatment covering almost all the aspects. I have got the answers to all my questions regarding bunion treatment. Thanks for sharing.

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  4. Thanks for this info. Have the yoga toes but don't wear them nearly as often as I should. I will start implementing them into daily 30 min use.

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    1. Good luck!!! After buying my wife some Yoga toes for a small bunion, they sat on her desk for 2 years. She only started wearing them faithfully when her Pilates instructor told everyone in the class to get them since they were better than sliced bread!! Rich

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  5. Thank you so much for taking the time to provide this advice! I am a 30 yo with hereditary hallux valgus. I rarely ever had bunion pain - even through 16 years as a ballet dancer and 4 years on pointe! About 6 months ago I took up two new hobbies: a Japanese martial art called katori and ballroom dancing and my MTP joints have started aching. These conservative options are exactly what I was looking for in hopes that I can slow the bunion progression. I'm especially grateful for your recommendation of a night splint. I spent hours reviewing these but could never decide which is best and which are bogus.

    I have a few questions, if you’re still monitoring this thread and have the time to answer:
    1. What is your opinion on menthol-containing products like Tiger Balm and Biofreeze? Would they be a good idea in conjunction with the massage?
    2. I found one video you posted on bunion taping (incidentally, I have learned a lot on Lisa Howell’s site). Would that work with Rocktape? If not, might you recommend a method for bunion taping with Rocktape? There are so many options for taping that I have no idea where to start.
    3. I also found the video you posted demonstrating metatarsal doming exercises, and I’m eager to start those. Are there any other exercises you recommend for strengthening the small muscles of the feet? (Besides the balancing one in another of your blog posts on bunion care – I can balance on each foot with my eyes closed, but I make sure to do that regularly!)

    I would really appreciate any advice. I’ve read through much of your blog and you seem like exactly the type of podiatrist I would like to find! I will, of course, go see a local podiatrist, but it will be a few months before I can see one on my HMO plan and I want to start as soon as possible to relieve pain and, most importantly, slow the progression of the deformity.

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    Replies
    1. Thanks Jessica, here is the link to my response. Rich

      http://www.drblakeshealingsole.com/2016/03/hallux-valgusbunion-email-advice.html

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    2. Thank you so much! I just taped my right foot following that video (it's the one in the worst condition - based on how you describe the stages it might be between II and III). I'll work on the exercises starting tonight.

      I have one more question that came up while I was taping: I noticed that on my right foot the toe has a medial rotation in it. Looking sideways at my foot (e.g. sitting in a chair with my right ankle resting on my left knee), I see the entire big toe toenail. On the other foot, I see the appropriate side profile (so, the top of that toenail is in line with the tops of my other toenails whereas on the right feet, the toenail is facing medially).

      I was just wondering if this is a typical presentation of hallux valgus and if there are special modifications on the typical bunion exercises one might do to address that.

      Thank you again for being so helpful!!!

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    3. Jessica, that is the valgus part of Hallux Valgus deformity. So it would be seen more deviated that direction on the side of the larger bunion. You can definitely attempt to stretch the toe away from the second toe and rotate it in the opposite direction for 30 seconds repeat twice, and do 3 times a day. Good observation BTW. Rich

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    4. Will do! Thanks so much. I really appreciate all your advice and information. This is a great blog!

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  11. A bunion is a bump that forms at the joint of the big toe that is made up of bone and soft tissue. This abnormal bony mass forms when your big toe pushes against your other toes, making the big toe joint go in the opposite direction. This abnormal position causes the toe joint to enlarge, and this crowds your other toes and leads to pain. This deformity is also known as hallux valgus. I find a website for the Best Shoes for Hammertoes. If you want you can visit this site.

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  12. Wow, I never knew some of these products existed. I have a question though, if you do not mind. Would hot compression help treat bunions in a way?

    Very Informative article, thanks!

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  13. Hello,I will be seeing my 2nd Podiatrist tomorrow. I have a stage 4 bunion on my right foot. I've already seen 1 Podiatrist who strongly recommenderecommended surgery. I've been unsuccessful in finding information regarding foot pain associated with a stage 4 bunion. I'm experiencing severe foot pain, sharp pains,burning and muscle spasms in my right foot. Can a stage 4 bunion be the primary cause of my severe foot pain? Sincerely,Jennifer

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    1. Oops,I made a mistake when I published my question. I apologize for accidentally double clicking on the word....recommended. I would appreciate a reply to my question regarding my stage 4 bunion. The stage 4 bunion is located on my left foot. Why I said my right foot? I've no idea,however,I am inclined to believe it's something to do with the time,and the fact that I have yet to sleep. Sincerely, Jennifer

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  14. was wondering if there is something like a Night Splint for a bunionette (littlest toe)? I've looked & cannot seem to find anything at all. Thank you.

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  15. Interchangeable shoes could well prove to be the answer for parents whose children never seem to be happy with their shoes. This article looks at why they are proving to be so popular.I find this website for Shoes for Big Feet. You can visit this site.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.