By: Lily Hoog-Fry & John Baker
What are Bunions?
Bunions, medically known as ‘Hallux Valgus,’ represent a structural change often caused by a lifetime of wearing shoes that constrict our toes. They manifest as a seemingly "stuck" first ray—the area where the base of your big toe meets the inside of the foot—giving the appearance of a pointed toe, even without shoes. This deformity involves inflammation and causes the big toe joint to protrude inward, while the big toe itself crowds or even crosses the second toe as it shifts laterally (first metacarpophalangeal joint adduction).
Severe bunions can make finding comfortable, narrow shoes impossible and often lead to significant pain in the big toe, reduced foot stability, and a decreased quality of life (Hurn et al, 2016). To prevent bunion formation and the associated severe pain, we advocate for shoes with a wide toe box and no arch support. Minimizing the time spent in ill-fitting footwear that forces your feet into unnatural positions allows your foot structure to strengthen naturally.
Common Causes of Bunions in Women & Men:
The Hallux Valgus deformity is alarmingly common; it affects a quarter of individuals aged 18-65 and more than a third of adults over 65 (Hurn et al, 2016). While a predisposition for bunions can be inherited due to family foot morphology, they are most frequently observed in women who regularly wear heels with tight toe boxes and men with flat feet (Nguyen et al, 2010). The link between high heels and bunions in women is biomechanically clear: these shoes act almost like orthotics, pushing the foot into a position that encourages bunion development.
For men, flat feet are a significant underlying cause of bunions, creating a similar biomechanical stress to wearing high heels. The bunion forms because flat feet lead to excessive inward rolling of the feet (pronation), causing the medial longitudinal arch and medial ankle to drop. This misalignment forces the foot bones into an unfavorable orientation, angling and rotating the big toe inward. This rotation is critical because it causes the joint to flex at an inward angle, accelerating the progression of the bunion. Prolonged walking with this pronated foot posture mimics the stress of wearing high heels, and the repetitive microtrauma and improper loading eventually lead to the formation of painful "bony lumps" or a "bony bump" at the base of the big toe.
Flat feet are also associated with weakness in the intrinsic muscles that support the medial longitudinal arch. One particularly crucial muscle in bunion formation is the abductor hallucis. Although smaller and with less leverage than its adducting counterpart, strengthening this muscle is vital for reshaping the first ray and improving foot health.
The Truth About Bunion Surgery:
It's important to understand that non-surgical treatments may not suffice for extremely severe bunions. In such cases, surgical techniques like ‘Arthrodesis’ or ‘Distal Osteotomy’ might be necessary (Ferrari, 2009). However, surgery is not a definitive solution for all foot problems; it carries risks of bunion recurrence, complications, and months of recovery with limited mobility (Nguyen et al, 2010).
Before considering surgery, we strongly encourage exploring non-surgical bunion treatment options. Foot exercises specifically designed to enhance biomechanical foot function have demonstrated clinical effectiveness in treating bunions and reducing pain, as confirmed by a systematic review in the Journal of Foot and Ankle Research involving 589 participants (Nix et al, 2013).
Given that bunions exist on a spectrum of big toe ADDduction (the toe moving towards the midline of the foot and crowding other toes), it is possible to achieve positive changes in bunion pain, associated numbness, and deformity. These improvements also extend to aesthetic considerations and overall foot stability, ultimately enhancing the quality of life and foot health.
Beyond the crucial step of replacing constraining footwear with barefoot shoes that offer ample toe box room, effective, science-backed bunion movement therapy targets specific movements. The underlying principle is that bunions stem from excessive pronation (inward rolling of the foot) and the subsequent incorrect inward bending and rotation of the first ray (Karabicak et al, 2015).
Get That Big Toe Back Out!
Firstly, we must address the toe-off stance during gait. Just before pushing off the back leg when walking, the big toe joint requires not only sufficient mobility to extend (dorsiflex) towards the top of the foot but also the ability to generate propulsive force. A big toe affected by a bunion struggles with both. Therefore, a key intervention involves manually guiding the big toe outward, restoring its optimal position for push-off. This can be achieved through various methods, including toe spacers, manual manipulation, or even KT tape, which a study showed could reduce pain and the angle of deformity in women's bunions over 10 days (Karabicak et al, 2015). Increasing the time spent using these methods to encourage your toe joints back towards the midline of the body will significantly benefit your feet.
Connecting to Dusty Muscles:
The next phase focuses on strengthening this newfound big toe mobility through toe abduction exercises (Karabicak et al, 2015). While seemingly simple, these exercises demand considerable focus. Try standing and gently lifting your big toe slightly up and primarily outward, away from the center of your foot. It can be very helpful to touch the medial longitudinal arch where the abductor hallucis muscle is located and use this kinesthetic cue to ask yourself, “Can I activate this muscle?”
Correcting the Foot Deformity:
Secondly, we need to enhance the foot’s capacity to move out of pronation and into supination (Karabicak et al, 2015). This action will elevate the medial longitudinal arch, effectively preventing the cascade of the foot falling inward, which leads to the big toe tilting outwards and eventually rotating inwards—the hallmark of Hallux Valgus. A recommended exercise involves placing a wide resistance band around your ankles and another between just your first toe knuckles, maintaining some tension. While keeping weight through your big toe (and ensuring the toe band doesn't slip), slowly lift the arch of your foot up and out, working against the tension of the ankle band. Repeat this slowly until you feel a gentle burn of muscle fatigue in your arches.
Magic Movement to Reduce Bunions!
Finally, to combine big toe mobility with supination strengthening, we introduce the Foot Screw exercise. This technique is remarkably effective in addressing bunions. Begin by placing only your big toe down, angled 45 degrees towards the midline of your body. Then, using friction to keep the big toe in place, screw the rest of your foot into lateral rotation so that the foot (not the toe) faces forward. At this point, the big toe should appear to be pointing medially relative to your foot, and your medial longitudinal arch will be engaged and lifted. Practice moving under load in this position—for example, set your feet like this before light squats or while standing to do dishes. As it becomes easier, you can add slow and controlled toe raises. A wider splay of your big toes provides a broader base of support for your foot, which reduces the rotational stability demands on upstream joints like the knee and hip, making you feel more stable and stronger throughout a lifetime of movement. Hallux Valgus has even been linked to an increased risk of falls in the elderly (Nix et al, 2013).
In summary, before considering surgery or simply attributing bunions to genetics, dedicate time to improving your foot mechanics, using toe spacers, and wearing shoes that truly accommodate the natural shape of your feet. The sooner you begin focusing on your foot health, the less likely you are to develop bunions, or the more likely you are to see positive changes in existing ones. Set that big toe free!
