Do you have a nagging, annoying pain in your big toe that prevents you from walking or doing your daily activities? Now quick, look down at your foot! Do you see a bony deformity on the outside of your big toe? If you answered yes to these two questions, you may be dealing with a bunion, also known as hallux valgus deformity. But not to fear! Treatment exists to help your symptoms, and there is a lot you can do to prevent them from worsening or experiencing a new formation of a bunion. In this article, we discuss all things bunions and what YOU can do to manage your big toe pain with foot bunion exercises!
What is a bunion and what causes it?
A bunion, the common term for the condition called hallux valgus, is a visible bump or deformity that forms on the joint at the base of your big toe. This often looks like an overgrowth of bone but is actually a malalignment of your 1st metatarsal (first joint of the big toe, where it connects to the rest of the foot). Over time, the tip of the big toe will move inward, toward the rest of the toes, and cause pain and/or overcrowding of the foot inside your shoe. It may make walking, sports, or daily activities more difficult due to the pain it causes. You may observe the skin in the area of the bunion becoming reddened or increasingly dry and itchy.
There are a few main causes for bunion formation. Bunions form more commonly in women, and this is due to the fact that high heels (or any ill-fitting shoewear) are the main cause of bunion formation. Sorry ladies! In fact, according to a study by Dufour et al, women who begin wearing high heels between the ages of 20-64 showed a 47% increase in bunion development in their lifetime (1).
In addition to ill-fitting footwear and high heels, the main risk factors for bunion development are:
- Genetics/hereditary cause
- Arthritis and other bone conditions
- Foot overuse and sports
- Traumatic injury
It has also been speculated that tightness in the Achilles tendon and calf muscles can cause a muscular imbalance between the flexor and extensor surfaces of the foot (2) and cause the arch to flatten and the toes to spread out, eventually leading to bunion formation. Particularly in running and jumping athletes, excess pressure and weight-bearing can occur at the base of the 1st metatarsal, sometimes in excess of 400% of body weight, as compared to 80% of body weight from normal walking (3).
Thankfully, there are things we can do to prevent bunion formation and still enjoy our activities!
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How can I prevent a bunion from forming?
An ounce of prevention is worth a pound of cure, am I right?! Maybe the most impactful thing you can do to prevent bunion formation is correct shoe selection. As a general rule, the toe box (front section) of the shoe should be wide enough to accommodate all of the toes, with a bit of space between the first toe and the end of the shoe material. You should be able to spread your toes slightly within the shoe. This may mean going up a half size or getting a “wide width” version of your shoe. You can listen to more about shoe fitting in this podcast episode.
For an athlete, temporarily modifying a training schedule could be helpful. This may include reducing jumping and excessive weight-bearing temporarily until treatment is put into place and pain starts to subside. Those experiencing bunion and first toe pain could also consider the use of orthotics placed into the shoes, as well as a bunion shield or padding inside the shoe to help relieve symptoms and excess pressure on the first toe. Orthotics should flexibly support the arch of the foot and prevent too much forward movement within the shoe. Other treatments such as corticosteroid injection and/or a short course of physical therapy may be indicated.
Conservative treatments are meant for symptom relief, and to prevent worsening of the bunion deformity in an individual.
Watch Our Youtube Video On How To Manage Big Toe Pain!
Do I need surgery?
As with most orthopedic problems, conservative methods as discussed above are always implemented first to help relieve symptoms before jumping to a surgical option. For surgery to be considered, patients must have failed conservative treatment, experienced persistent pain, and impair a person’s functional abilities (4). Surgeries are often also done more frequently in the athletic population, due to the need to return to sport quickly as well as restore function to the first toe.
The most popular surgical approach to correct a bunion is the Chevron osteotomy, which usually takes 8-9 weeks to recover from (5). However, there are over 130 surgical approaches for bunion correction, including minimally invasive techniques, and the procedure should be tailored to the person’s individual situation. Most often, patients are on crutches and non-weight bearing for several weeks following surgery, and rehab/physical therapy is performed post-surgically, also for several weeks. Physical therapy should focus on swelling management, range of motion, foot strengthening, balance, implementation of proper footwear for ongoing use, and return to an individual activity.
Discussion with a surgeon should always occur before a surgical approach is considered!
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What are some exercises I can try?
Foot exercise that is focused on mobilization, improving range of motion, and strengthening can be very beneficial in managing bunion symptoms and improving function. Here are a few to try!
Sample Foot and Ankle [P]rehab Program Exercise
- How: Get set up seated if you’re performing this for the first time, the goal is to progress to standing. While keeping your arch lifted by doming your foot, spread your toes apart as far as you can, hold for a moment then return to starting position. When performed correctly, your arch will raise in height and all of your toes will spread apart from one another.
- Feel: You should feel your foot and arch muscles working with this exercise, you should also feel your arch tighten up and the muscles in between your toes working.
- Compensation: Try to keep the rest of your foot and your heel on the ground, try to keep your toes in line with one another, do not excessively extend/flex your big/little toe, and do not move your foot side-to-side
Foot on Wall – Calf Stretch
Big Toe Lift
Towel Crunch for intrinsic foot strengthening
If you are experiencing pain in your big toe and notice a bump-like deformity, you may be experiencing a bunion. With preventative techniques, exercises, and conservative methods to relieve pain, and changing up your footwear routine, you can get significant relief from this condition and be able to enjoy walking and fun activities without discomfort!
Take Control of Your Foot and Ankle Health!
The Foot & Ankle complex connects your leg to the environment. It acts to translate and accept forces from the leg to the ground and from the ground to the leg. Whether your goal is to decrease discomfort, improve walking ability, or prevent future foot & ankle injuries from happening you’re in the right place!
- Dufour, A. B., Casey, V. A., Golightly, Y. M., & Hannan, M. T. (2014). Characteristics associated with hallux valgus in a population-based foot study of older adults. Arthritis Care and Research. https://doi.org/10.1002/acr.22391
- Perera, A. M., Mason, L., & Stephens, M. M. (2011). The pathogenesis of hallux valgus. The Journal of Bone and Joint Surgery. American Volume, 93(17), 1650-1661. https://doi.org/10.2106/JBJS.H.01630
- Saxena, A., & McCammon, D. (1997). The ludloff osteotomy: A critical analysis. The Journal of Foot and Ankle Surgery, 36(2), 100-105. https://doi.org/10.1016/S1067-2516(97)80053-1
- Wülker, N., & Mittag, F. (2012). The treatment of hallux valgus. Deutsches Arzteblatt International, 109(49), 857-867; quiz 868. https://doi.org/10.3238/arztebl.2012.0857
- Saxena, A. (2000). Return to athletic activity after foot and ankle surgery: A preliminary report on select procedures. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 39(2), 114-119. https://doi.org/10.1016/S1067-2516(00)80035-6
About The Author
Taryn Beumont, PT, DPT, CLT, CF-L1, CNC
[P]rehab Writer & Content Creator
Taryn was born and raised in Maine and still resides there with her boyfriend and son. Taryn received her Doctorate in Physical Therapy from Husson University in 2010, and also carries a Bachelors in Kinesiology and Human Movement Science. She is a Certified Lymphedema Therapist, a Certified Crossfit Level 1 Trainer, and a NASM Certified Nutrition Coach. Taryn has 10+ years of experience in many different realms of PT, from the young athlete to the geriatric patient. Taryn considers herself a ‘lifelong learner’. She has special interests in oncology care and breast health, dry needling, and Crossfit training. In her free time, Taryn enjoys fitness, spending time with her family, continuing education, writing and reading, and is very excited to be a part of The [P]rehab team to educate and empower others to take control of their own health and wellness.
Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.