Are you worried that your big toe is starting to point in? You've been told you'll never wear your favourite high heels again? Or have you been told that you’ll need an operation to correct a ‘bunion’.... we are taking a look at the causes of bunions and the different ways an osteopath can help improve your foot's health and relieve aches and pains.
What Are Bunions?
The medical term for bunions is Hallux valgus (hallux = big toe, valgus = away from the midline). It is true that bunions are more rife in shoe wearing populations, however, the common belief that tight shoes are the cause is disputed. From an anatomical viewpoint, bunions are due to the first metatarsal bone, the bone carrying the big toe, growing at an angle away from the second metatarsal. To compensate, the end of the big toe (the phalanges of the big toe) will then angle back in towards the second toe, leaving the joint protruding out, causing discomfort, and often calluses, by rubbing on the inside of the shoe.
A commonly stated and accepted truth is that you inherit bunions from your parents... this, however, should be up for debate. Whilst there are studies that show strong links in families, you are not born with bunions. It is not the bunions themselves that are hereditary but some of the diseases like RA(rheumatoid arthritis) and gout, which may give you more sensitive toe joints meaning you will be more susceptible to bunions. Clearly some foot shapes are also inherited like flat feet, toe shape and length (like ‘Roman’ toes), which may also predispose you too bunions. However, these are risk factors... you do not inherit the condition itself.
Another myth is that bunions are fluid filled sacs.This is confused with bursitis. However, bunions are bony protrusions. After excessive rubbing on the side of your shoe, a blister may develop on top of the bunion, but the bunion itself is the joint line of the big toe.
Another myth is that high heeled shoes cause bunions and this is reinforced by the fact that a lot of bunion sufferers are women. However, whilst narrow pointy shoes may aggravate an already existing bunion, they are NOT the root cause.
Why Do Some People Get Bunions?
- Low arches. People with low arches (or flat footedness) are more susceptible to bunions. This is because a low arch will cause differentiations in the distribution of weight on the foot. There is more weight on the inside of the foot creating more pressure on the big toe and more stress on the first metatarsal joint where bunions develop.
- Long big toes. The shapes of the toe can be square or round but there is often a slight extra length in the first toe on people with bunions, creating a larger angle (valgus) and a more pronounced protruded joint.
- Pronationof the foot, where the arch of your foot naturally prefers to roll inwards more on impact during walking and running, is often associated with the condition. As this is more of a lean on the medial aspect of the foot it causes extra stress on the bunion area.
- Hypermobilityis also thought to exacerbate the problem as the tissues move more easily and are more likely to bend towards the problem area.
- Leg length differencemay also play a part as this will flatten the arch causing pronation on the longer leg creating more pressure through the 1st metatarsal bone, the big toe.
- Your muscles: Transverse and oblique hallux muscles bowstring the hallux away once it has started its journey, at which point all the long foot muscles then start pulling from a position off-centre, increasing the angle and hence bunion. (This is one of the main treatment approaches for osteopathy!)
How Your Osteopath Can Help With Bunions and Foot Health
- Your osteopath can assess the integrity of your medial archand work through some exercises to strengthen it.
- To improve the weight distributionin your foot during your natural walking gait your osteopath can work at encouraging more dorsiflexion and opening up your hips, altering awkward gait patterns. Hip position can impact knee and in turn ankle, arch and toes and vice versa, so your osteopath can work through your whole body to keep it all in balance.
- For excessive pronation your osteopath can work on other mechanisms in the leg that help you supinate your foot like calf strength. They can set you calf raises as home exercises.
- Visit your osteopath for plantar fasciitis relief. This is a fascia strain (the tissues between your skin and your muscles) in the arch of your foot through overuse - a type of repetitive strain common in runners, presenting as a shooting pain on the sole of your foot. Your osteopath will use some manipulative techniques to work out the connective tissues in the foot, and work farther up the leg on knee, hip and pelvis mechanics.
- Your osteopath can also give you advice on foot support. Some special shoes and insoles can reduce excessive load over time by improving mechanical imbalance. They may even slow the progression of the bunion deformity.
Foot health is important so look after your feet! And your body will follow. Foot issues can lead to compensation in other structures such as ankles, knees, hips and even back so it’s important to access therapy rather than live with discomfort.