By Robyn Gant, Director
Having managed my own bunion and hallux valgus deformity for the past 20 years I was able to relieve pain and maintain joint mobility with some specific soft tissue massage, stretching and understanding what features to look for in a shoe.
Following these steps self management strategies can help you delay or even avoid the need for surgery.
1. Referred pain from irritable trigger points in tight muscles
Two muscles which can cause pain in people with hallux valgus are the adductor hallucis and flexor hallucis brevis muscles under the foot. The adductor hallucis muscle which is in the shape of the number seven, pulls the big toe towards the second toe and attaches to the outside of the big toe joint and the outside sesamoid bone under the foot. It has a transverse head which attaches to the base of the 5th metatarsal of the little toe and an oblique head which attaches to the bases of the 2nd to 4th metatarsals. The Flexor hallucis brevis muscle bends the big toe down and attaches to the cuboid bone in the middle of the foot and the base of the big toe. The two small weight-bearing sesamoid bones sit within the tendons of the two heads of this muscle. The crosses in the diagrams below indicate the trigger points , which are nerve endings in the muscle that can become painful and refer pain in the areas shaded in red.
To release tension and decrease pain from these you need to deactivate the trigger points first and then do some specific soft tissue massage along the entire muscle, including its attachment points into the bones. To locate the muscles, sit with your foot resting on the other knee to allow you to access the sole of your foot. If this position is painful for your hip or knee try sitting on the bed or couch with a cushion under your knee for support.
Relax your toes and feel for taut bands in the muscles under the forefoot. To locate the trigger points feel along the taught band of muscle to identify a tender spot and mark it with a pen.
To deactivate the trigger point you can use a technique I call muscle meditation.
- Find tender spot in muscle
- Touch painful point with index finger
- Ensure only one point of contact with skin
- Reduce pressure so there is no pain
- Deep breath in
- As you breathe out, think about relaxing the muscle just under your finger
- Repeat twice for each point.
- Without moving the finger retest the spot for pain.
Once you have deactivated all the trigger points then you can release the ends of the muscles with a little massage cream such as skin repair. It takes about 2 minutes to ease tenderness at each attachment point and massage along the length of the muscle. It is good to pull the big toe away from the second to as you do this.
2. Big toe joint compression and stiffness
Test how far you can pull your big toe away sideways from the second toe and note if it is painful or stiff. Test for tenderness along the outside of the big toe joint. If this is tender massage along it towards the end of the toe, pulling the big toe away from the second toe as you do this until the discomfort eases. Retest how the big toe feels when you pull it away from the second toe.
You can help maintain the sideways mobility of the big toe by wearing some thongs with adhesive felt padding wrapped around the toe piece in the house. I recommend the Scholl Orthaheel wave thongs which are contoured, cushioned and feel secure on your feet. The padding applied to the toe piece will compress a little over time so you may need to add another layer to maintain effectiveness. It is advisable to sit with the padded thongs on for 10-30 minutes 1-2 times per day over a few days before you try walking around the house in them. When you take the thongs off observe the space between the first and second toe.
A bursa is a fluid filled sack that exists to protect bony prominences in the body from friction and pressure. Inflammation of the bursa is referred to as bursitis and occurs occurs if the bursa is subjected to increased compressed and fraction for a period of time.
The bursa on the inside of the big toe joint can become inflamed if the shoe is too tight across the front of the foot. When this occurs the bursa becomes painful, red and swollen and any pressure from a shoe will irritate it.
To settle this you will need to wear thongs or sandals that don’t touch the bursa and treat it with topical application of anti-inflammatory gel such as Voltaren gel to reduce the inflammation, combined with Hirudoid cream to reduce swelling under a sealed dressing for 5 consecutive nights. As these creams do get into the blood stream and may cause allergic reactions be sure to check with your pharmacist before using them.
To avoid bursitis with bunions it is important that you choose shoes that are wide in the forefoot, stretch easily with a low to medium heel height.
- with stitching across or near the bunion
- patent leather or viny shoes which don’t stretch
- high heels with increase the loading of the forefoot
- with straps that cut across the bunion
Ideal shoe materials are suede, elasticised fabrics or soft fabrics.
Ideal heels are stiff soled low wedge platforms which are curved under the forefoot and minimise loading and movement of the forefoot during walking. Here are a few examples:
Ara for wide fit, suede and soft leathers
Bernie Mev or Kolourful Katie for elasticised uppers
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.