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 2^nd hammertoe as in the Stage 4 bunion above, use a Budin Splint (also known as Single Loop Hammertoe Regulator) to get the 2^nd 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