Video Transcript

In this video, we will discuss hallux valgus. Hallux valgus is the deviation of the great toe towards the lesser toes. This does not always result in pain. But pain is common when wearing tight-fitting or inappropriate footwear such as heels. Those who do experience pain typically get tenderness and redness at the outer border of the joint, progressing the pain at the top and bottom of the joint or with movement of the toe.

One of the conservative treatments for hallux valgus is a night splint. This works to straighten the great toe at night, decreasing pressure on the joint and reducing stress on the ligaments surrounding it. Second, ensuring that footwear is wide enough at the forefoot to decrease excess pressure on this area. Bunions stretching the shoe is a great option to accommodate this deformity.

What is Hallux Valgus?

Hallux valgus, also known as bunion deformity, occurs when the joint of the big toe moves out of alignment. This often causes the joint to deviate towards the outside of the foot, and the toe to move on the opposite angle, towards the smaller toes. As a consequence, a bump forms at the joint.

The development of hallux valgus is thought to be multifactorial and may be due to environmental factors, which include poor fitting footwear, and structural factors (hereditary predisposition, excessive pronation), or a combination of the two (2).

What Are Symptoms of Bunions & Hallux Valgus?

HV affects each person individually, with a range of symptoms that may result in pain or discomfort, or the presence of structural deformities absent of pain.

Early symptoms of Hallux Valgus can include:

Joint stiffness
Joint swelling
Redness
Joint pain
Development of a bump over the big toe joint

Progressive manifestation of symptoms

Joint pain
Structural deformity of the big toe
Structural deformity of the second toe; as the first toe deviates towards the second toe, it can cause it to cross over the first toe or result in a hammer toe deformity, corns, blisters, or other pain in the second toe
Decreased balance—increased risk of falls (3)
Slower walking speed
Difficulty walking across uneven surfaces
Muscle weakness
Decreased joint range of motion
Increased foot pressures under the ball of the first toe
Difficulty ascending or descending stairs

In elderly patients, an unstable gait pattern may be associated with hallux valgus, including decreased walking speed and stride length over uneven surfaces (3).

Risk Factors of Hallux Valgus and How to Relieve Bunion Pain

Unfortunately, hallux valgus affects all factors of the population, but is found to be more prevalent with certain risk factors.

Factors That Can Increase your Risk of Bunions include:

Age: chance of developing hallux valgus increases with age

Female: studies suggest hallux valgus is more prevalent in females; may be linked to excessive high heeled shoe use

Joint injury: repetitive or traumatic injuries to the big toe joint may increase the development of hallux valgus

Activities: exercise or occupations that increase the stress on the big toe joint can result in the manifestation of the deformity, including ballet dancers or gymnasts

Because it may manifest with a multifactorial onset, avoiding hallux valgus may be difficult, especially if there is a family history. You can reduce symptoms of pain associated with bunions by avoiding risk factors including:

Ill-fitting footwear
High impact exercise
Ample rehab/physical therapy prior to returning to sport or activity post-injury
Excessive weight gain
Activities/actions that increase symptoms of pain

What Are My Options for Treating Bunion Pain?

Treatment goals for individuals with hallux valgus include pain and symptom management, while allowing the individual to complete activities of daily living (ADLs) with greater function and mobility. Early treatment intervention is important as it may provide greater joint stability and slow the progression of the deformity and consequently improve or maintain your quality of life (3).

Conservative Hallux Valgus Treatment Options Include:

Custom orthotics & orthotic insoles
Cushioning: off-the-shelf pads and toe sleeves
Accommodative footwear
Bunion night splint
Physiotherapy and stretching
Medications
Injections

In severe cases of Hallux Valgus, surgical interventions may be necessary. This type of intervention should only be discussed after conservative treatment options have been exhausted without significant pain relief or management.

Hallux Valgus Treatment Professionals

There are several healthcare providers and other professionals that may help with symptom and exercise management. Other professionals may include:

Dieticians
Kinesiologists
Physiotherapists
Occupational therapists
Foot care nurses or chiropodists

Staying Active with Bunion Pain

Conservative treatments of Hallux Valgus, which may include custom bunion orthoses and/or changing your current footwear, play a key role in maintaining and staying active with hallux valgus.

While it is important to stay active, limiting your activity to movements that are not painful or less intensive will provide symptom relief.

Ensure that you have appropriate footwear for your activity needs. Your footwear choices may enhance your exercise or inhibit it without you even knowing it.

Always listen to your body, and allow for ample rest time when needed. Consult with your physician, physiotherapist, or kinesiologist before starting a new exercise program, or if you have any questions regarding your fitness plan.

Reduce Bunion Progression and Prolong Surgery as Much as Possible.

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How can SoleScience Help Treat Your Bunion Pain?

Your SoleScience Pedorthist will create an individualized treatment plan that suits your specific needs, goals, and symptoms. We will work with you to determine not only what we need to do to address your current concerns, but also to prevent future problems.

Your pedorthist will complete a thorough and comprehensive foot examination at your initial appointment. A comprehensive follow-up exam will ensure that you are meeting your goals and allow your pedorthist to reassess your treatment plan (as necessary). During these appointments we will:

Assess joint and muscle function, including range of motion and gait assessment
Assess your footwear for both fit and function
Identify any risk factors that can be modified and make recommendations for change
Identify areas of risk with specialized tools such as pressure mapping (F-Scan or Pedograph)
Discuss a treatment plan, which may include a change in footwear, activity modification, or custom orthoses and/or a complementary treatment referral (such as physiotherapy)

Treat Hallux Valgus or Bunions with Custom Orthotics

In addition to your individual treatment plan, your SoleScience Pedorthist will provide you with educational resources to help you maintain your foot health.

Specific to hallux valgus, your pedorthist may recommend a bunion night splint to help slow the progression in the early stages. Custom foot orthoses have been shown to decrease overall pain and symptomatic factors as well as slow the progression of the deformity as a conservative treatment plan (4). Your pedorthist may also recommend using a toe sleeve over your second toe to decrease pressure points associated with the movement of your big toe.

The Importance of Hallux Valgus Orthotics

Hallux valgus (HV) is a prominent joint disorder, more common among women than men. The prevalence of hallux valgus today can present a considerable individual burden due to symptomatic pain, development of OA and abnormal gait patterns (1).

Conservative treatment interventions have been shown to decrease symptoms of pain and discomfort, slow the progression of hallux valgus and therefore delay or reduce the need for surgical interventions.

Custom Orthotics vs OTS Devices for Hallux Valgus Treatment

Custom Orthotics for Hallux Valgus

Custom foot orthoses are made using a mold (cast) of your foot. This type of insole is made specifically for you and your needs. Your pedorthist will take a cast of your foot in a specific position and choose the materials and construction details tailored specifically to you. The evidence suggests that custom foot orthoses can be a viable part of your treatment plan to decrease symptoms of pain and discomfort and aid in movement function (4).

Off the Shelf Orthotics for Hallux Valgus

Off-the-shelf (OTS) devices are pre-fabricated for an “average” foot and are designed to slip into most footwear. This type of insole may be heat moldable or modifiable for a degree of customization, but is not custom-made to your foot. There are dozens of insoles available in your local pharmacy or drugstore that may provide support and relief for various foot conditions. When dealing with the early stages of hallux valgus, an OTS device may be appropriate for pain management, but as the hallux valgus progresses, a custom orthotic device for Hallux Valgus may be better suited to your overall needs.

Footwear Recommendations for Hallux Valgus and Bunions

Your footwear choices are an integral part of your treatment plan and day-to-day comfort. Ensure that your shoe choices include cushioning and support, with extra depth through the forefoot, a stiff heel counter, and a proper fit. The shoes should not be too wide or too narrow, or place any increased pressure on any area of the foot. A stiff rocker toe may be beneficial as well, as it will decrease the effort required to toe off at the end stage of your walking cycle.

Footwear: Features to Look For to Accommodate Bunions:

Wide, deep toe box to accommodate for toe deformities
Seamless construction through the upper shoe – will limit the pressure on or around the big toe joint
Laces or buckles as closures may provide a better fit overall than slip-on styles
Avoid heeled shoes as much as possible

Your pedorthist will recommend shoe choices for you, and will take into consideration the most appropriate shoes for work and activity requirements. If necessary, your pedorthist may also be able to stretch or modify your shoes to provide more comfort, especially around the first toe.

Make a confident choice in SoleScience, and we’ll do everything in our power to make you a raving fan!

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