Examining the Foot: Hallux Valgus

Hallux valgus, or a bunion, is a bump one gets on the side of the base of the big toe when the big toe deviates inward. Yes, that is the classic explanation but what is really happening to the big toe?

Besides the three bones that make up the big toe (metatarsals, proximal and distal phalanges) there are also four muscles and two small bones (sesamoids) that support the big toe. When these bones and muscles shift from their anatomical position they no longer offer mechanical advantage to propel the big toe.

Sadly the changes don’t stop at the level of the big toe, but travel all the way up to the knee and hip joints changing their mechanics. Some individuals may notice discomfort in either one or both knees, hips, and low back without even realizing that the discomfort might be sourced at the foot level.

If possible, it can be beneficial to catch these anatomical changes in the big toe at their early stages. Once a bunion is formed the treatment plan is about symptom management rather than repair. Part of the plan is to retrain proper muscle activation in the foot and the front of the leg. Moreover, encouraging movement in certain joints of the foot, ankle, knee, hip and the low back are fundamental to overall treatment approach. Working together with a manual therapist is highly encouraged in order to slow down the progression of the condition.

Besides the hands-on care, your manual therapist can suggest other conservative aids. Changing your shoes is one of the most common recommendations. Finding a shoe with a wider toe box and softer leather coverage can be crucial for long term stability and mobility of the foot. Your manual therapist might also suggest the following management aids: taping, bracing, using toe spaces, and bunion pads. In some cases a temporary orthotic can help the person passively regain some degree of support.

Best advice, don’t wait until the changes in your toe anatomy impact the entire kinetic chain.

Written by Dr. Marina Liarsky, BScKIN, DC; 2017