Bunions are bony protrusions that usually occur on the outside of the big toe.
They are one of the more common foot deformities, with as many as one-quarter to one-third of adult Americans suffering from bunions. They are also more common in women and the elderly.1 As with many other health conditions that are frequent among seniors, most patients will not make the trip to the DC’s office until after traditional, standard therapies have been tried and failed.
What causes bunions?
Bunions (hallux valgus) are the result of hereditary deformities of the metatarsophalangeal (MTP) joint, which is at the base of the big toe.1,2 The first metatarsal bone of the foot shifts outward, causing the big toe to be shifted inward, toward the rest of the toes. When this happens, the MTP joint will jut outward, which will become further irritated by friction against shoes. The bursa will eventually become irritated, leading to pain and stiffness of the big toe.1.2 This may eventually lead to changes in the gait, which can bring a whole host of other problems, including knee, hip, or lower back pain.
Shoes that do not have adequate room in the toe box are the most common culprit for exacerbating bunions, especially high heels, that shift the body weight further forward, putting extra pressure on the toes as they are forced further forward. This very well may explain why bunions are 10 times more likely to occur in women than in men.1 Other conditions that may exacerbate bunions include flat feet, fallen arches, and excessive amounts of standing per day. Interestingly, professional ballerinas often suffer from painful bunions as a result from having to be en pointe for dancing.1
The most common standard treatments will start with proper footwear that has enough room in the toe box, along with a low heel of no more than one inch.1 Warm soaks, cold compresses, night splinting, and NSAID pain relievers may alleviate symptoms.1-3 Cortisone shots will temporarily relieve swelling and pressure in the big toe. If conservative treatment fails, surgery to shave off the bony protrusion and re-align the big toe can be considered.1,2
A2011 study in the Foot Journal compared use of a night splint (15 patients) to manipulative therapy (15 patients) in terms of scores for pain, function, and angle degree of big toe dorsiflexion.3 Patients undergoing manipulative therapy received four treatments over the course of two weeks.
At the end of the two week period, there were no statistical or clinical differences in scores between the two groups of patients.3 However, the group receiving manipulative therapy continued to have improved scores at both one-week and one-month follow-up periods, while the control group using night splints showed a drop in scores at follow-up.3 The researchers concluded that manipulative therapy to treat bunions may be a viable alternative for cases in which it may be premature to consider surgery or when surgery may not provide significantly better results.
Unless your existing patients mention the beginning of bunion symptoms, it may be rare for you to catch this condition while in the early stages (this is also a good example of why you should do regular foot checks on your older patients). Fortunately, chiropractic care can help with bunions and provides a far less invasive option than surgical intervention.
- What to do about bunions. Harvard Women’s Health Watch. Accessed 3/25/2016.
- Bunions can occur at any age. Accessed 3/25/2016.
- du Plessis M, Zipfel B, Brantingham JW, et al. 2011. Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: An exploratory randomised clinical trial. Foot (Edinb), 21(2);71-78.