There are several approaches to addressing bunions and if you’re someone who has been experiencing foot discomfort, then you are for sure looking for the best solution.
In this article, we’ll take a look at bunion prevention measures – what does the conservative approach offer and what does a conventional approach deliver?
Conventional Approach to Bunion Prevention
If you’re suffering from bunion and you were to go for conventional podiatric care, you would likely receive an x-ray of your foot which would measure the angulation between the first metatarsal and the second metatarsal to determine if that’s beyond average or beyond normal.
Once the angulation gets beyond 10 to 12 percent, oftentimes people are recommended to have a portion of their metatarsal bone resected and the head of the metatarsal bone slid over.
You would also likely recommend having a custom orthotic for arch support – and the reason for that is as we’ll discuss today.
When the big toe goes out of its alignment the arch does not function properly. In other words when the big toe goes towards the second toe as is the case with most conventional footwear, the joint just below the ankle, the subtalar joint will undergo more flattening or more pronation.
So conventional recommendation would be an x-ray, custom orthotic, and if your foot’s angulation is enlarged and you are in constant pain, you would probably be offered a bunionectomy. And what a bunionectomy is is what I just mentioned a moment ago there is bone removal, there is joint realignment, and internal fixation placed.
Conservative Approach to Bunion Prevention (by Correct Toes)
What’s interesting though about that conventional approach and how it differs significantly from our conservative approach is we educate our patients to understand that this angulation here that’s occurring is not a growth of bone. Instead of the growing bone on the inside of the foot, what has actually occurred is the first metatarsal bone has literally been forced away from the second metatarsal bone by the big toe.
Many of you would wonder how in the world can your big toe dislocate your first metatarsal, how does it happen early on in your life? Everybody is born with the great toe in direct line with the first metatarsal, more in keeping with the way our right foot is.
Shortly after birth, the footwear that becomes available for all of us begins this process of crowding our toes. Oftentimes painlessly and this feature is called tapering of the toe box.
For instance, our patient Rebecca, over the course of her lifetime she was an athlete. And most of her lifetime she wore lots of shoes for various athletic events that held her big toe in an inward position. When the big toe is held in that position, the extensor tendon to the top of the big toe (extensor hallucis longus) and the flexor tendon to the bottom of the toe (flexor hallucis longus) are now pulling on this angle:
The way that the Correct Toes approach differs significantly is we rarely take an x-ray of the patient right off the bat, we generally educate them that we’re not likely to see anything other than a dislocated joint and at that point what we do is we go about a process.
Most importantly showing the patient how all of their footwear leading up to their visit has been dislocating their big toe as well as their fifth toe. Bunion prevention is ensuring that the patient has an opportunity to understand how their footwear created the problem.
For the foot to function, normally we need a shoe or many shoes for her activities that are going to be literally shaped like a natural foot.
What the patients will understand is, as their big toe goes back into a proper alignment, the flexor hallucis longus (muscle to the bottom of the big toe) will better lift up under a shelf of bone on the inside of the heel bone. This little shelf of bone has a special groove for that flexor hallucis longus that comes out under and all the way to the end of the big toe.
So as the patient reapproximates their big toe, they also begin to understand how that great toe influences their arch.
For patients who are more interested in conservative preventive care, we get the footwear that’s going to enable the change, we teach them a series of self-care, and we encourage the client to understand their bunion condition.
In Conclusion
Something that limits the progression of bunion prevention is many times before somebody gets to us and gets the information about stretching out their adductor with proper footwear and using a splinting device called Correct Toes.
Many of those folks have gone so many years in this direction that their adductor is so tight and contracted and short that when they use a splinting product, instead of the splinting product nicely moving the toe back where it belongs, the splinting product, unfortunately, ends up pulling the other toes up and over because the adductor is too tight.
So that’s one thing that you’ll need to be aware of, the other slight contraindication is if the individual has developed a very large intermetatarsal angle, before they come to see us we may never completely close down that angle. We will be able to get greater flexibility in the direction of the big toe so that’s a good reason for people to try to address their bunion early on in their life so that they can have more success with preventive conservative care.
Transcript
If Rebecca were to go for conventional podiatric care she would likely receive an x-ray of her foot which would measure the angulation between the first metatarsal and the second metatarsal to determine if that’s beyond average or beyond normal.
Once that angulation gets beyond 10 to 12 percent then oftentimes people are recommended to have a portion of their metatarsal bone resected and the head of the metatarsal bone slid over.
They would also likely recommend that Rebecca’s arch be supported with a custom orthotic and the reason for that is as we’ll discuss today when the big toe goes out of its alignment the arch does not function properly. In other words when the big toe goes towards the second toe as is the case with most conventional Footwear the joint just below the ankle the subtalar joint will go undergo more flattening or more pronation
So conventional recommendation would be x-ray custom orthotic and if this angulation were enlarged and Rebecca were in constant pain she would probably be offered a bunionectomy. And what a bunion ectomy is is what I just mentioned a moment ago there is bone removal, there is joint realignment and internal fixation placed.
Conservative Approach to Bunion Prevention(by Correct Toes)
What’s interesting though about that conventional approach and how it differs significantly from our approach is we educate our patients to understand that this angulation here that’s occurring is not a growth of bone if we were to look at an x-ray of Rebecca’s foot the x-ray from the top to the bottom we would notice that instead of her growing bone on the inside of her foot what has actually occurred is her first metatarsal bone has literally been forced away from the second metatarsal bone by her big toe
So many of our audience members are going to wonder how in the world can your big toe dislocate your first metatarsal how it does that is early on in our life everybody is born with the great toe in direct line with the first metatarsal more in keeping with the way Rebecca’s right foot is
Shortly after birth though the footwear that becomes available for all of us begins this process of crowding our toes oftentimes painlessly and this feature is called tapering of the toe box. So over the course of Rebecca’s lifetime she was an athlete most of her lifetime she wore lots of shoes for various athletic events that held her big toe in this position and when the big toe is held in this position the extensor tendon to the top of the big toe extensor hallucis longus and the flexor tendon to the bottom of the toe flexor hallucis longus are now pulling on this angle and consequently if they’re pulling back on this angle the toe is going to go that way and the metatarsal is going to go that way.
So this is the reason why people will develop an increase in that first intermetatarsal angle it’s called so the way that our approach differs significantly is we rarely take an x-ray of the patient right off the bat we generally educate them that we’re not likely to see anything other than a dislocated joint and at that point what we do is we go about a process of:
A. Most importantly showing the client how all of their footwear leading up to their visit has been dislocating their big toe as well as their fifth toe. Preventive bunion work is to ensure that the patient has an opportunity to understand how their footwear created the problem
For her foot to function normally we need a shoe or many shoes for her activities that are going to be literally shaped like a natural foot
What the client will understand is as their big toe goes back into a proper alignment, the flexor hallucis longus muscle to the bottom of the big toe will better lift up under a shelf of bone on the inside of the heel bone. This little shelf of bone has a special groove for that flexor house as long as it comes out under and all the way to the end of the big toe
So as the client reapproximate their big toe, they also begin to understand how that great toe influences their arch.
So that person who is more interested in conservative preventive care we get the footwear that’s going to enable the change we teach them a series of self-care.
We have a bunion stretch that’s located on the website where we encourage the client to understand that their adductor pollicis muscle which attaches to the big toe and attaches to the little floating bone on the bottom of the big toe known as the fibular sesamoid when that adductor muscle gets very tight the abductor muscle here gets very long and weak and it can no longer do its job to help Rebekah support her foot and straighten out her big toe
We may be able to see the abductor here as i push Rebecca’s big toe into shoe position you. If you notice under the skin here you’ll see a subtle bit of movement there that is Rebecca’s abductor hallucis in an ideal world that muscle would be strong and short and holding Rebecca’s toe over here and when it learns to do that Rebecca will also notice a significant component of structural integrity in her arch
So here’s where getting the big toe out not only reverses a bunion deformity it’s also intimately related to proper arch function.
Something that limits the progression of bunion reversal is many times before somebody gets to us and gets the information about stretching out their adductor proper footwear and using a splinting device called Correct Toes many of those folks have gone so many years in this direction that their adductor is so tight and contracted and short that when they use a splinting product instead of the splinting product nicely moving the toe back where it belongs the splinting product unfortunately ends up pulling the other toes up and over because the adductor is too tight.
So that’s one thing that you’ll need to be aware of the other slight contraindication is if the individual has developed a very large intermetatarsal angle before they come to see us we may never completely close down that angle we will be able to get greater flexibility in in the direction of the big toe so that’s a good reason for people to try to address their bunion early on in their life so that they can have more success with preventive conservative care.
