Having managed my own bunion and hallux valgus deformity for the past 20 years I was able to relieve pain and maintain joint mobility with some specific soft tissue massage, stretching and understanding what features to look for in a shoe.

Referred pain from irritable trigger points in tight muscles

Two muscles which can cause pain in people with hallux valgus are the adductor hallucis and flexor hallucis brevis muscles under the foot. The adductor hallucis muscle which is in the shape of the number seven, pulls the big toe towards the second toe and attaches to the outside of the big toe joint and the outside sesamoid bone under the foot. It has a transverse head which attaches to the base of the 5th metatarsal of the little toe and an oblique head which attaches to the bases of the 2nd to 4th metatarsals. The Flexor hallucis brevis muscle bends the big toe down and attaches to the cuboid bone in the middle of the foot and the base of the big toe. The two small weight-bearing sesamoid bones sit within the tendons of the two heads of this muscle. The crosses in the diagrams below indicate the trigger points , which are nerve endings in the muscle that can become painful and refer pain in the areas shaded in red.

To release tension and decrease pain from these you need to deactivate the trigger points first and then do some specific soft tissue massage along the entire muscle, including its attachment points into the bones. To locate the muscles, sit with your foot resting on the other knee to allow you to access the sole of your foot. If this position is painful for your hip or knee try sitting on the bed or couch with a cushion under your knee for support.

Relax your toes and feel for taut bands in the muscles under the forefoot. To locate the trigger points feel along the taught band of muscle to identify a tender spot and mark it with a pen.

To deactivate the trigger point you can use a technique I call muscle meditation.

Muscle Meditation

1. Find tender spot in muscle
2. Touch painful point with index finger
3. Ensure only one point of contact with skin
4. Reduce pressure so there is no pain
5. Deep breath in
6. As you breathe out, think about relaxing the muscle just under your finger
7. Repeat twice for each point.
8. Without moving the finger retest the spot for pain.

Once you have deactivated all the trigger points then you can release the ends of the muscles with a little massage cream such as skin repair. It takes about 2 minutes to ease tenderness at each attachment point and massage along the length of the muscle. It is good to pull the big toe away from the second to as you do this.

Big toe joint compression and stiffness

Test how far you can pull your big toe away sideways from the second toe and note if it is painful or stiff. Test for tenderness along the outside of the big toe joint. If this is tender massage along it towards the end of the toe, pulling the big toe away from the second toe as you do this until the discomfort eases. Retest how the big toe feels when you pull it away from the second toe.

Maintaining mobility

You can help maintain the spaces between your toes by wearing some toe spreaders such as Correct Toes or Flamingo Feet. The advantage of these toe spreaders is that they stretch the transverse head of the adductor hallucis muscle which runs across the metatarsal heads from the big toe to the little toe. This is important to avoid compression on the nerves between the metatarsal heads which can lead to painful neuromas. These devices are designed to walk in and work well with grip socks, adjustable slides or Lems shoes which have a wide forefoot that allow your foot to move.

Bursitis

A bursa is a fluid filled sack that protects bony prominences from friction and pressure. Inflammation of the bursa is referred to as bursitis and occurs if the bursa is subjected to increased compression and friction for a period of time.

The bursa on the inside of the big toe joint can become inflamed if the shoe is too tight across the front of the foot. When this occurs the bursa becomes painful, red, and swollen and any pressure from a shoe will irritate it.

To settle a bursitis you will need to wear secure adjustable slides, thongs or sandals that don’t touch the bursa. You can treat the bursa with a topical application of anti-inflammatory gel such as Voltaren Gel to reduce the inflammation, combined with Hirudoid cream to reduce swelling, under a sealed plastic dressing for 5 consecutive nights. As these creams do get into the blood stream and may cause allergic reactions, be sure to check with your pharmacist before using them.

Footwear advice

To avoid bursitis with bunions it is important that you choose shoes that are wide in the forefoot, stretch easily with a low to medium heel height.

Avoid shoes with

• stitching across or near the bunion.
• patent leather or vinyl shoes that don’t stretch.
• high heels which increase the loading of the forefoot.
• straps that cut across the bunion.

Ideal shoe materials are suede, elasticised fabrics, or soft fabrics.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.