April 2015

Bunions
 
 
A bunion (hallux valgus) is the displacement of the big toe characterized by a bony mass on the inside base of the 1st metatarsophalageal joint (1st MTP).  The condition affects many people, is very common in the running community, and is 10x more prevalent in women than men.  It is a condition that typically develops over time and is a sign that there is uneven load distribution through the foot.  There are many theories why people develop bunions, but the most common reason a bunion may develop is due to pronation of the medial longitudinal arch of the foot.  When walking or running, the forces placed through an unstable arch are transmitted to the  forefoot.  As these excessive forces pass through the forefoot, the metatarsal bones are forcefully spread apart.  The muscle adductor hallucis attaches to the inside base of the big toe and holds the first metatarsal firmly in place.  The repeated excessive force is transmitted through the 1st MTP and leads to permanent bony joint deformation/degeneration over time.   
 
Adductor Hallucis Muscle (top view)

Causes:

•  Pronation/flat feet

•  Improper footwear

•  Genetic shape of the bones of the foot

Signs/Symptoms:

•  Pain, redness, swelling in the 1st MTP

•  Deformation of the 1st MTP

•  Callus formation on the 1st MTP

•  Decreased mobility of the 1st MTP

Treatment:

•  Rest, Ice, Elevation, NSAIDs

•  Professional assessment and fitting of orthotics

•  Soft tissue assessment and treatment

•  Muscular structures that stabilize medial longitudinal arch

•  Muscular structures in the plantar foot and involved with the big toe

•  Rehabilitation exercises to strengthen stabilizers of medial longitudinal arch

•  Surgical consult if conservative methods fail

The importance of an accurate diagnosis and treatment of a dysfunction of the big toe is the fact that the big toe bears the majority of the load during walking and running.  When there is a structural deformity and functional loss of of the big toe, the body will naturally compensate by shifting those forces on secondary and tertiary structures.  This load shift can lead to other physical dysfunctions of the foot and lower extremity. 
 
Active Performance Chiropractic focuses on the diagnosis, treatment, and rehabilitation of athletic-related injuries. Treatment is a unique blend of Active Release Techniques, traditional chiropractic therapy, and physical rehabilitation designed to match each patient’s goals and lifestyle.