Physiotherapy treatment of bunions
An individual with bunions may have the condition managed without surgery or may have to undergo surgery to obtain pain relief. The main goals of management include:
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• To relieve the pressure and pain caused by irritation on the foot
• To halt any further growth of the bunion as the continuous enlargement causes more irritation on the foot
• To appropriately correct any foot deformity that may have developed
• To optimise the distribution of the individuals’ weight in the whole foot when standing, walking, running etc
• To assist the individual to resume his/her daily activities
Management of bunions takes into consideration the severity of the condition and the individuals’ goals for treatment.
Management involves:
• Pain relief – If the bunion becomes painful and swollen, you can place ice in a towel and rub over the surface of the foot between 15 – 20 minutes, several times in the day.
• Splinting – A splint is a device used to correct inappropriate positions adopted by the body. A night splint may be used to reduce the size of the bunion and straighten it or realign the joint properly while you sleep.
• Wearing appropriate footwear – You may also need to change the kind of shoes you put on so that the bunions do not grow worse.
You need to find good fitting shoes to address the symptoms, and that implies finding shoes with a wide front or toe box.
• Insoles – Custom-made insoles may also be inserted in shoes to assist in the realigning of the foot and direct pressure away from the bunion. The insoles also help to provide foot arch support for those with flat feet.
This is especially important to stabilise the joint and keep the joint of the foot in the appropriate position for walking and standing.
Management of bunions include performing exercises:
• To strengthen the entire foot and maintain joint mobility
• To prevent stiffness in the foot
• To maintain the correct alignment of the toes
• To build and stabilise the arches of the foot.
Toe lifts
Sit with your foot flat on the floor and gently raise your toes as far as possible towards the ceiling and bring them down. Ensure that the ball of your toes and inner heel are firmly on the floor as you lift your toes.
You can also lift up all your toes, and while keeping your small toes lifted up gently bring only your little toe downwards towards the floor.
This exercise can be modified so that you raise all your toes and then gently lower only your big toe down towards the floor.
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Afterwards spread your toes and keep your middle toes lifted up and gently bring only your big toe and little toe downwards towards the floor.
Toe bends
Sit on a chair and place your foot on a low stool with your toes hanging over the edge of the stool.
Gently bend toes towards the floor and raise them to the neutral position. Repeat several times.
Toe pulls
Gently pull each toe outwards with your hand and hold for five seconds.
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Heel raises
Sit with your foot flat on the floor and with your knees bent. Gently raise your heel to the limit you can tolerate while keeping your toes on the floor.
Standing heel raises
Stand against a wall and gently raise your heel to the limit that you can tolerate and hold for five seconds.
Everyday tips
•Do not choose your shoes simply based on the size marked inside the shoe. Always pick the shoes which fit your foot instead.
• Opt for footwear that takes the shape or comes very close to taking the shape of your foot.
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• Whenever you purchase footwear, you need to stand during the fitting process and ensure that there is sufficient space for your longest toe at the end of each foot.
• Ensure that the ball of your foot fits well into the widest part of the footwear.
• Do not buy shoes that are too tight simply because you expect your foot to stretch it so that it fits later.
• Ensure that you walk in the shoes you purchase just to know that it fits and feels right.
The Writer is a Senior Physiotherapist at the 37 Military Hospital
(panierus@live.com)