Not the loveliest of thoughts, but if you’re reading this then chances are you may well have one or possibly even two.
A bunion (hallux valgus) is a condition where the big toe points inwards towards the other toes. It is a deviation at the metatarsophalangeal (MTP) joint of the big toe. It makes the inner edge of the first tarsal bone jut out to the side which rubs on shoes and can become inflamed and painful.
Unfortunately, treatment often tends to be quite superficial. It’s true that it can be caused partly by wearing poor footwear, and that the tendency can be hereditary. But more often it is the result of how you are moving. So fixing the aesthetics without addressing the underlying problem will only lead to recurring issues.
In my last post I spoke about the Spiral Line: one of the fascial continuities defined by Thomas Myers.The spiral line allows us to move forwards with greater efficiency, by using the torque created by the cross lateral co-ordination of arms, trunk and legs during walking and running.
Relying on this torque without the underlying support of the inner line of the body (the core), causes a downward spiral, where people are literally twisting around their joints. The bunion is a symptom of this twisting.
(Small interlude here: I have come across at least one client for whom the bunion resulted from an adjustment in her gait pattern due to inflamed sesamoid bones in the big toe joint. So if correcting the alignment of the toe, by using your fingers to pull the toe back into alignment, and trying to roll over the big toe joint, causes pain, it may be that the rotation around this toe is an adjustment and that there is an underlying problem that needs to be addressed. Even so, the management described below would not hurt.)
There are two things that need to be addressed to correct the deviation of the big toe joint:
- Tone the muscles within the spiral line to bring more stability into the joints of the lower limb. (Please see my Spiral Line – Practical post to learn more about how to bring tone to the Spiral Line.)
- Address the movement restrictions in the other lines which may be causing you to take the spiral pathway in the first place.
I just want to pick up on this second point because it’s often left out. What I see quite a lot with people who have some degree of bunion is that their sagittal plane movement (forward and backwards) around the ankle and toes is restricted. They find it hard to do a standing knee bend (a plie) without letting the heels come off the floor, or they have a restriction around the metatarsal joints during push off. Whereas collapsing into the spiral line is a problem of tone, using it to by-pass forward/ backward movement is a problem of mobility.
So do we just need to stretch? Yes A simple calve stretch will help to increase mobility in the angle joint. My favourite is Katy Bowman’s rainbow calve stretch and the soleus stretch here. However, I’m tending to move away from stretches in general because they can sometimes be quite counterproductive and just lead to more stiffness. My favourite mobilisations around the ankle joint are the Feldenkrais variations of footwork. I try to include some of these in my classes from time to time but here’s a little sequence for you to try out:
(Apologies for my very basic filming skills and for the shadows under my eyes. I’m really not made for the camera!)
If you notice, I basically haven’t said much about targeting the big toe itself. That’s partly because there’s so much stuff out there about specific toe exercises. I just don’t think the toes are really the cause. My feeling is that it is often stiffness around the ankle joint and collapsing into the arches that changes the push off during walking so that instead of articulating forwards through the big toe and second toe metatarsals people are twisting around the big toe which brings about the bunion. The exercises described above and in previous posts may help to bring some tone and release into the foot and ankle joint which will help to unlock this pattern. But bringing your awareness to how you’re moving will also help.