A bunion is a deformity of the metatarsophylangeal (MTP) joint, in which the big toe deviates toward the other toes, leaving the appearance of a bump at the base of the big toe. This bump may produce pain when it rubs against footwear. Bunions--along with its closely associated condition, hallux valgus--may be caused by wearing shoes that are too narrow. According to Dr. Ray McClanahan, a sports podiatrist based in Portland, Oregon, bunions are preventable and correctable using non-surgical techniques.
Wear Flat, Wide and Flexible Footwear
Almost all conventional footwear on the market has tapered toe boxes, which push the hallux--or large toe--against the others. Many shoes, including athletic shoes, also elevate the heel, which further increases the pressure on the already-misplaced hallux and its MTP joint. Dr. McClanahan recommends choosing footwear that is completely flat and possesses a wide toe box--not only at the ball of the foot, but also at the ends of the toes. This allows the hallux to align properly with the first metatarsal, thereby reducing the bunion configuration.
Use a Toe-Spacing Device
Place a gel or silicone device between the hallux and the second toe to return the big toe to its appropriate alignment. Dr. McClanahan explains that keeping the toes properly spaced during weight-bearing activity provides the best results. He adds that when using a toe spacer inside footwear, it's essential to ensure that the shoe's toe box is wide enough to easily accommodate the splayed toes. To test for sufficient wideness, remove the shoe's insole and stand on it. No part of the foot should overhang the liner.
Perform Toe Stretches
Chronic malposition of the big toe leads to an imbalance in the muscles and tendons that attach to the hallux, particularly the abductor and adductor hallucis muscles, according to Dr. McClanahan. This can be corrected by gently stretching the large toe away from the other toes while applying counter-pressure at the MTP joint--where the bump occurs. This stretch helps increase the range of motion of the big toe.
Be Persistent and Patient
It takes many years, even decades, for feet to conform to narrow footwear and bunions to form. Natural correction of the foot's anatomy also takes time. Persistence and patience with the treatment do pay off, and gradual changes in the big toe's alignment do occur.
Changes in footwear affect all muscles, tendons, ligaments and joints of the foot and leg. Introduce all modifications slowly and progressively so the body has time to adjust. Many patients experience some soreness at first, which dissipates as the muscles of the foot and lower leg become stronger. People with diminished sensation of the feet--such as those with diabetes or other neurological or circulatory impairment--should seek the advice of the health care professional before implementing any of the above suggestions.
