A Guide to Physical Therapy for Bunions
Did you know that over 20% adults under 65 suffer from bunions? Additionally, over 30% of adults older than 65 suffer from bunions.1 If you are looking for relief, physical therapy for bunions is a great option. In this blog post, we will discuss symptoms, causes, diagnosis, treatment options, and prevention tips.
While there are often aesthetic concerns with bunions, they can also make it difficult to walk or wear shoes. Bunions are the most common foot deformity that people deal with — particularly women — and can lead to pain, disability, and a rapid reduction in quality of life.
Typically, bunions are not completely reversible. However, they can be optimally managed to prevent unnecessary progression, reduce any subsequent pain, and boost function. Don't feel stuck or like you have to settle.
- Understanding Bunions
- Symptoms Associated with a Bunion
- What are the Most Common Causes of Bunions?
- Diagnosing Bunions
- What to Expect from Physical Therapy for Bunions
- What If Conservative Treatment Doesn't Work?
- Preventing Bunions
- Is It Time to Seek Treatment?
Hallux valgus is a condition that involves a progressive deformation of the largest joint in the big toe, known as the metatarsophalangeal joint (MTP).
With bunions, the outer connective tissue of the MTP becomes compromised. Over time, it causes the big toe to start to shift. This causes the base of the big toe to point laterally (outward), while the end of the digit points medially (inward), crowding the other toes of the foot.
As the deformity progresses, a bony prominence or "bump" from extra tissue growth develops on the outer aspect of the MTP joint, known as a bunion.2
The most common symptom associated with a bunion is pain. This can be caused by the deformity itself, as well as from skin rubbing against shoes. The pain is often worse when walking or wearing shoes that don't fit well.
Other symptoms may include:
- Inflammation and/or redness around the MTP joint
- Swelling of the foot
- Difficulty walking or reduced range of motion in the big toe
- Toe/foot stiffness
- Changes in walking (gait) mechanics
- Weakness of the intrinsic foot muscles
- Calluses or corns on the side of the foot, often due to friction from shoes
- Previous injuries to the big toe, such as turf toe
The exact underlying mechanisms that cause bunions are largely unknown or not well understood. However, there are a number of different factors that can contribute to the development of hallux valgus and bunions. These include:
- Genetics: Certain congenital foot structures are more susceptible to bunions, which tend to run in families3
- Foot structure: Such as a flat foot or tightness of the Achilles (calf) tendon
- Gender: Women are up to 10 times more likely to be affected
- Shoe choices: Wearing shoes that are too tight or have high heels4
- Age: Bunions are more common as we get older
- BMI: Higher BMI has been linked with an increased risk of bunions
- Joint problems of the lower body: Changes in walking mechanics from knee or hip osteoarthritis are correlated to structural foot changes (and visa versa)5
- Foot injuries: Trauma to the MTP joint can predispose someone to develop a bunion
- Joint contractures: Limited range of motion in the big toe (known as hallux rigidus) can lead to toe deformity
- Systemic disease: Conditions such as diabetes, rheumatoid arthritis, or gout may contribute to development
The gold standard for diagnosing hallux valgus and bunions is with an X-ray. This allows your physician to look at the angle of deformity in the big toe joint (MTP). In general, any angle larger than 15 degrees is diagnosed as hallux valgus.2 When the angle of deformity is greater than 45 degrees, it is considered severe.
A CityPT physical therapist or podiatrist can also perform a physical assessment of your feet. This will help to identify any abnormal foot mechanics, muscle imbalances, or stiffness that may be contributing to the development of your bunion. They can then work with you to develop a personalized treatment plan that will start facilitating pain relief.
The goal of physical therapy for bunions is to help reduce pain and improve function. Your specific treatment will be based on the underlying causes of your bunion, as well as any other contributing factors identified during your assessment.
Common interventions that may be used to treat bunions include:
- Joint mobilizations: To help improve the range of motion in the big toe joint (and surrounding joints of the foot, ankle, and beyond)
- Soft tissue mobilization: To help release any tightness in the muscles or tendons around the foot and lower leg
- Strengthening exercises: For the intrinsic foot muscles, calf muscles, and other muscles that support the foot and lower leg
- Balance and proprioception exercises: To help improve the stability of the foot and ankle
- Gait retraining: To help correct any abnormal mechanics that may be contributing to your bunion
- Orthotic prescription and/or taping: To provide support for the foot and help offload the bunion to allow tissue healing and slow any angle progression
- Shoe recommendations: To help improve the fit of your shoes and reduce any further irritation to the bunion
- Modalities: Such as ice, electrical stimulation, or ultrasound, which can help to reduce pain and inflammation in the short term
- Education: Most importantly — a CityPT clinician will help you learn about your condition, underlying causes, how to confidently manage your pain/prevent progression, and more
In some cases, conservative treatment (physical therapy, orthotics, changes in shoe gear, etc.) may not be enough to provide long-lasting relief. When this is the case — and the pain is severe and affecting your daily life — your healthcare provider may recommend more invasive options, including:
- Surgery to correct the misalignment (most often a release of restricted tissues)
If you do need surgery, post-operative physical therapy will help you recover optimally and manage the original underlying causes.
While genetics and other predispositions cannot be prevented, there are factors that can be managed. The best way to prevent bunions is to identify any risk factors you may have and take steps to address them. This includes things like:
- Wearing shoes that fit well and support your feet — avoid high heels, tight shoes, or shoes with a narrow toe box.
- If you have flat feet, high arches, or other foot deformities, wearing orthotics or appropriate shoes can help to support your feet and prevent unnecessary complications.
- Exercising regularly to maintain good muscle balance and flexibility throughout your lower extremity.
- Managing any underlying conditions (e.g., arthritis, diabetes) that may increase your risk.
- Practicing healthy habits to manage overall tissue health and minimize inflammation, including adequate hydration, sleep, nutrition, and stress management.
If you are experiencing pain in your feet, especially around the big toe joint, it's a good idea to seek professional help. It's always best to get holistic guidance that can help prevent your toe pain from progressing in severity and disrupting your normal life activities.
A CItyPT physical therapist will be able to assess your condition and identify any underlying causes that may be contributing to your symptoms to help you sustainably manage your symptoms.
Book an appointment with one of our foot specialists today.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010 Sep 27;3:21. doi: 10.1186/1757-1146-3-21. PMID: 20868524; PMCID: PMC2955707.https://pubmed.ncbi.nlm.nih.gov/20868524/ ↩
Mortka K, Lisiński P. Hallux valgus-a case for a physiotherapist or only for a surgeon? Literature review. J Phys Ther Sci. 2015 Oct;27(10):3303-7. doi: 10.1589/jpts.27.3303. Epub 2015 Oct 30. PMID: 26644698; PMCID: PMC4668189.https://pubmed.ncbi.nlm.nih.gov/26644698/ ↩ ↩2
Hannan MT, Menz HB, Jordan JM, Cupples LA, Cheng CH, Hsu YH. High heritability of hallux valgus and lesser toe deformities in adult men and women. Arthritis Care Res (Hoboken). 2013 Sep;65(9):1515-21. doi: 10.1002/acr.22040. PMID: 23696165; PMCID: PMC3775916.https://pubmed.ncbi.nlm.nih.gov/23696165/ ↩
Barnish MS, Barnish J. High-heeled shoes and musculoskeletal injuries: a narrative systematic review. BMJ Open. 2016 Jan 13;6(1):e010053. doi: 10.1136/bmjopen-2015-010053. PMID: 26769789; PMCID: PMC4735171.https://pubmed.ncbi.nlm.nih.gov/26769789/ ↩
Golightly YM, Hannan MT, Dufour AB, Renner JB, Jordan JM. Factors Associated with Hallux Valgus in a Community-Based Cross-Sectional Study of Adults with and without Osteoarthritis. Arthritis care & research. 2015;67(6):791-798. doi:10.1002/acr.22517.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440851/ ↩