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Hallux valgus – Bunions

Bunion’s consist of a thickened callus, an inflamed bursa and excess bone forming at the side of the first metatarsal head (big toe).

Bunions are diagnosed by the following symptoms:
A bulging bump on the outside of the base of the big toe
Swelling, redness or soreness around the big toe joint
Corns or calluses — often where the first and second toes overlap
Persistent or intermittent pain in the area of the big toe
Restricted movement of the big toe if arthritis affects the toe

My treatments and recommendations
Avoid wearing tight shoes especially high heels with pointy toes. Buy footwear that is wide in the toe box area.
Shoe pads are an option especially if they offer relief.
I teach all of my hallux valgus patients awareness exercises: “Always try to straighten the big toe.” I have them press the big toe into the floor and slide the other four toes and foot laterally until the big toe is as straight as possible. This is how I want the patient to stand all the time.
Stretch the feet and calfs. I am yet to meet a patient with bunions that does not have tight calfs. I have my patients stand with the forefoot on a ½ foam roll (3” high) with the heels on the ground for 2 minutes at a time twice a day. After about two weeks they are able to stand up straighter while doing this stretch. Calf tightness can be a cause of low back pain in and of itself so it is important to take this tightness out of the patient’s body.
Strengthening the involved side glutes, getting the hamstrings length and strength proper, and the peroneus longus strength up to normal is important because it allows the first metatarsal to resist the medially directed component of forces associated with hallux plantarflexion.
Use toe spreaders or a bunion splint especially while sleeping.
Massage CBD (Phyto-Zol) serum into the bunion area two to three times a day.
Shock wave therapy aka pulse wave therapy. I do this directly over the bunion area. This is an effective way to reduce bunion discomfort and even reduce the deformity itself.

Other ways to prevent and ease the pressure and pain caused by bunions include:
Watch your weight – remember, the rest of you is pressing down on your feet when you stand, walk or run.
Taping with Kinesio-tape is very helpful. I bring the big toe into a straight position and tape the toe. I teach the patient how to do this at home on their own.
Cover the bunion with a soft, cushioning, protective moleskin or gel-filled pad.
I check for their footwear and offer off-the-shelf shoe inserts or recommend custom made orthotics.
For the acute flare up I try warm foot soaks, ice packs, whirlpool, more CBD serum, etc.

This protocol has helped many patients avoid surgery.

 

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