According to Dr. James Brantington at the Dynamic Chiropractic website, bunions—also known as hallux abductovalgus or HAV—are a commonly seen deformity of the first metatarsophalangeal joint in which the hallux or big toe deviates toward the other toes. Bunions, which are a bone or tissue enlargement, may be painful. Chiropractic care for bunions uses conservative, non-invasive treatments to improve the feet's structural fitness and reduce bunion-associated discomfort.
According to Dr. Ray McClanahan, a Portland, Oregon,-based sports podiatrist and a leader in conservative foot care, conventional footwear is the principle cause of bunion deformities. McClanahan states that the following quartet of problematic design features built into conventional footwear, including athletic footwear, contribute to bunion formation: heel elevation, toe spring, tapered toe boxes and rigid, inflexible soles. Tapering toe boxes, especially, are injurious to the foot during the developmental phase of human growth, and should be avoided to promote the feet's normal anatomical development. Chiropractic care for bunions emphasizes appropriate footwear selection. When possible, people should choose shoes that are widest at the ends of the toes—not at the ball of the toes, like most conventional footwear—and possess little or no toe spring. Footwear that allows the foot to act like a bare foot inside the shoe will reduce the likelihood of developing bunions.
Dr. McClanahan believes that human feet, in natural anatomical position, are widest at the ends of the toes and possess significant toe splay. After years of wearing conventional footwear, however, many people's feet are widest at the ball of the foot, and their toes deviate toward the midline of their feet. To help restore toes to their natural anatomical position, and to reduce the bunion configuration and bunion pain, McClanahan recommends using a toe-spacing product that slots in between the toes. Using a toe-spacing product will help the big toe migrate toward the outside of the foot, where it should line up with the inside edge of your foot. Toe spacers can be worn as a night splint to correct toe malpositions, although McClanahan states that the most rapid changes in abnormal foot and toe configuration can be achieved when toe spacers are worn during weight-bearing activity. He also counsels patients to select footwear that will accommodate the toe spacer or a bunion splint.
According to Dr. Brantingham and colleagues, chiropractic joint manipulation of a bunion will not favorably alter the bunion deformity. However, manipulation or mobilization of stiff, fixated foot and ankle joints may reduce bunion-related pain or discomfort. Joint mobilization of the big toe in all six planes of motion, along with light traction and warm hydrotherapy baths or other appropriate physical therapy modalities, may reduce inflammation of the intermetatarsal bursae—the fluid-filled sac between the metatarsal bones—and improve joint range of motion. Brantingham states that although the degree of bunion deformity often remains unchanged following chiropractic manipulation of the great toe, the improvements in flexibility make the patient feel more comfortable, which is especially relevant for post-surgical patients, who may experience prolonged immobilization and associated joint dysfunction in the first metatarsocuneiform and calcaneo-cuboid joints.