As you can see, I have bunions on both sides, my right being worse than my left.
There are a wide range of exercises and treatment options for bunions, but how beneficial are they?
Can they help reduce pain, improve function, and can they reduce the severity?
Tony Camilla, physical therapist.
And in today's video, I'm going to be explaining what bunions are.
discuss the various treatment options, and show you the three best exercises.
Within this conversation,
I'm going to provide some evidence on the topic, as well as discuss my personal experience since I have lived with Bunyan's my entire life.
Bunyan's are formerly known as Halix Valgis.
This is a progressive deformity, which involves lateral deviation of the great toe, and medial deviation of the first metatarsal.
It typically involves development of abony prominence on the medial aspect of the first metatarsal head.
The cause of bunions are not well known as there are likely multiple factors which contribute to the deformity.
Classification is based on radiologic assessment by measuring two angles, the valgus angle and the inner metatarsal angle.
Based on these angles, you are either classified as having mild, moderate, or severe bunions.
While you can measure these angles manually by hand or through a photo, these tend to be less accurate.
authors found that Halik's valgus angle measurements taken on photos
were on average 5.3 degrees less than radiographs with some error up to 15 degrees.
The primary reasons why you might be looking for exercises or treatments for bunions is either because you have pain,
a loss of function, or you're looking to correct the deformity or it's some combination of the three.
First of all, it's important to know that the severity of the deformity and pain and function are not directed.
while I have never received an x-ray of my feet,
I would say I fall into the moderate category,
so a Hallux-Valgus angle of somewhere between 20 and 40 degrees, with my right being worse than my left.
But I do not experience pain or any significant loss of function.
In contrast, you may fall into the mild category and experience higher levels of pain and difficulty with walking or other activities.
As far as the cosmetic appearance, the available non-operative treatment options for bunions may not be as advantageous as your own.
compared how custom-made orthotics would affect severity of bunions when compared to no treatment.
At a one-year follow-up, there were no significant differences between groups.
And authors concluded, custom-made orthoses appeared to have no effect in the evolution of mild and moderate halib's valgus during a 12-month period.
A 2001 study looked at the differences that surgery,
orthotics, and-treatment groups had on a variety of outcome measures at a 6- and 12-month follow-up.
After one year, authors concluded the orthotics do not correct the abductive valgus deformity of the great toe.
However, although unable to correct the deformity, the orthotic treatment showed effectiveness at the 6-month follow up.
Several other studies have looked at the effectiveness of tape,
splints, and toe separators, and have shown that while these may reduce pain, they do not seem to
make any significant changes in deformity in the short term.
In terms of exercises, I'm going to show you three options, which place an emphasis on big toe extent.
ankle planar flexion strength, as well as strength of the intrinsic foot muscles.
However, I would also strongly consider taking a comprehensive approach to rehab, meaning you
include these other exercises which challenge and strengthen the lower body, such as squats, deadlifts, bridges, both double and single.
as well as exercises which challenge single leg balance.
Exercise one, toe extension.
The ability to extend the big toe often becomes altered with bunions,
and depending on your desired activity, maintaining or improving this motion might be helpful.
An option I like to use for big toe extension is a self-joint mobilization.
as this allows you to comfortably control the range of motion you move through.
Start by stabilizing the base of your big toe right next to the Bunyan with one hand,
while you use the other hand to pull the big toe into an extended position as far as comfortable.
Hold for a couple seconds, then return to the start and repeat.
Perform this exercise for 2-3 sets of 10-15 repetitions, one to two times a Exercise 2.
Heal A of toe extension can alter push-off during walking and other activities.
activities, so theoretically, exercises strengthening the calves will be beneficial.
Furthermore, these muscles also help to support the foot and arch.
A good starting place is simply performing a double leg heel raise from the floor.
Lift the heels as high as comfortable and focus on squeezing your calf.
slowly lower down and repeat.
If you find the top position uncomfortable on the toe, you have a options.
First, you can reduce the range of motion you move through, go as high as you can before discomfort, and then slowly lower back down.
If you find you are unable to move through an adequate range of motion before pain, perform this exercise on a step or elevated surface.
This will allow you to move through more range of motion while still minimizing toe extension at the top.
Alternatively, you can perform a seated heel raise.
This will reduce overall body weight and load placed through the toe,
potentially making it more Now,
if you find the double-leg variation too easy, you can add an external weight or perform a single-leg variation.
Whichever variation you choose, perform 2 to 4 sets of 8 to 15 repetitions, add an appropriate intensity 2 to 4 times a week.
authors found that individuals with bunions demonstrated less activation of the abductor halicis during abduction and more during flexion compared to healthy subjects.
Typically, this muscle functions in the opposite way.
It primarily abducts the big toe or moves it outward and secondarily flexes it.
But with bunions, this muscles attachment is altered, which likely leads to this change in function.
This is why it is theorized foot intrinsic exercises targeting big toe abduction might be the most beneficial.
This leads us to the third and final exercise, toe spread.
Start by lifting all the toes off the floor,
push the little toe down towards the outside, and push the big toe down towards the inside, moving it into abduction.
When you watch a normal foot perform this exercise, it is more clear what the movement should be.
you see that I'm not great at this I can barely perform it on my left,
the less severe foot, and I cannot do it on my right.
This exercise is challenging, especially if you have never done it before.
It has been shown that those with mild halib's valgus have increased difficulty with this movement, even after two weeks of pressure.
However, like most exercises, over time you can improve your ability to abduct your big toe.
For the toe spread out exercise, perform for 20 minutes a day, three to four times a week.
As I mentioned earlier, a reason why you might be seeking treatment is in order to reduce the severity of the bunch.
When we look at studies that compare various treatments such as the use of night splints,
toe separators, the toe spread out exercise, or even a combination of these, there are a few big takeaways.
Some of these studies do show an improvement in Halix-Bauge's angle, but these changes are still relatively small, only a few degrees.
It is also important to consider how they measure this angle,
as some studies either measure it by hand or through a picture, and as we discussed previously, these are not very reliable.
We also need to look at the duration of treatment and the subjects you use.
The findings from these studies were often observed over the short term,
only 2 to 3 months, and the subjects used most often only had mild halic valgus.
the treatment options, like the toe spread out exercise, might have some short term effect, but we really do not know how beneficial they are.
or for even more severe cases.
I don't know if I would even notice a change in a few degrees,
but if you feel otherwise, then these options might be worth exploring.
In case it was not already obvious,
I personally do not perform the toe spread out exercise as I feel the need to demonstrate this movement,
not a top priority given my goals and lifestyle.
Rather, I prefer to place an emphasis on other exercises, lifestyle factors, as as exercise and activity modifications.
the ladder being an important consideration for those with bunions.
I no longer perform split squats or lunges since I find these uncomfortable on my back foot and ultimately takes away from the goal of
the exercise which is single leg strength.
Instead, I prefer rear foot elevated split squats since this removes the knee for toe extension on the back foot.
Push-ups and planks require the toes to be in an extension.
If this is not tolerable on any given day, I will place an object under my feet in order to create a slanted surface.
This new foot position will place the toes in less extension, therefore can be beneficial if you experience pain during these movements.
And finally, I walk and hike a good amount, and again, this is usually a non-issue.
I wear shoes that I personally find more comfortable, which tend to have a wider tone.
If walking does become a bit more sensitive on my feet,
I will then gravitate towards using a stiffer shoe, like a boot, since this helps minimize the toe extension I move through.
If you enjoy running or want to run, the presence of a bunion in itself should not stop you.
However, if you do experience symptoms with this activity, adjusting shoe wear, load management,
and the exercises and treatments discussed previously can all be options for reducing pain.
Over the years, I have tried a variety of interventions and exercises.
I did wear orthotics for years, but I have tried splints and toe spacers, but I didn't really find much benefit to them.
And as I mentioned previously,
I don't actively work on foot intrinsic strength or work on my toe extension as these just don't fit my lifestyle.
However, this does not mean that you should not either, as these can all be viable options for helping reduce pain and improving function.
However, from what we currently know, these do not seem to change the deformity to any significant degree in the short term.
I have always been embarrassed of my feet, so I understand that cosmetic appearance is really important to some people.
But as hard as it can be at times,
less emphasis should be placed on appearance, and rather you should focus on what you can do.
And know that there are a wide range of activity and exercise modifications to make, if needed.
One topic I did not discuss is The goal for this video was to review the non-operative treatment options available to you,
however, surgery is still a viable option in some cases.
For questions regarding this topic,
as well as others pertaining to your individual needs, it is recommended you speak to your doctor or another health care practitioner.
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