This is the first of a series that is designed to target common conditions and “trouble spots” in the body and give you a greater understanding of what could be going on and also providing some tools to help the process of improving function (and how it feels).
This first edition is all about the feet! So many people (if not you, likely people you know) have issues with their feet. It’s also a great place to begin because it’s literally our foundation.
We’re not really going to be talking about plantar “fasciitis”, because I’ve written about that before: over here. In saying that, the recommendations outlined here will certainly be beneficial for people recovering from plantar fasciosis.
This email is going to focus on hallux valgus (which is the lateral deviation of the big toe) and bunions.
Let’s get a scope of the issue first
Up to 23% of adults and 37% of the elderly population have been shown to have Hallux Valgus. (reference). That’s a lot of people. It’s often associated with pain and a loss of function (balance, for example and therefore highly correlated with falls).
Most people believe that bunions (and hallux valgus) is largely hereditary. But I’m about to throw a spanner into the works here and suggest that the genetic link for this set of conditions is low.
Not absent, but just not as important as you probably think it is. This twin study will tell you more about that if you’re interested (or upset with me).
In the above study the top risk factor for hallux valgus is footwear use. Tight and narrow footwear being the absolute worst. Which is also why women experience it substantially more than men.
So here’s my first recommendation that you probably already know and will roll your eyes at me for, but I’m going to say it anyway: stop wearing silly shoes that smush your foot into entirely unnatural shapes. Now that we’ve got that out of the way…
A step further (pun indeed intended):
Whether or not weakness of the intrinsic muscles of the feet was part of the cause of your big toe deviating from it’s original position, it’s most definitely a factor now.
With time spent out of it’s original position, the muscles surrounding the joint are going to be negatively impacted. This means they’re going to lose function and weaken over time, even if they weren’t weak to begin with.
You can test this out at home.
You could use toe spacers, but sometimes the hallux can be so generously deviated or so set in its ways that all the toe spacers will actually do is displace the more lateral toes and put a whole lot of pressure on the “pinky” toe to move away from the rest.
You could also use strapping tape to draw the hallux more medially. Like this:
This strapping immediately resulted in:Improved balance (both sides individually)Increased grip/purchase on the floorReduced eversionDecreased external rotation at the kneeIncreased sensation of muscle contraction within the footAs well as these changes, the exercises I mention below will often show you first-hand how under-active and weakened those intrinsics are. All this will become apparent because the intrinsic muscles of the feet will be more available for contraction after strapping or splinting.
Take a look at the immediate differences in motion – they might outwardly appear to be small differences, but they are actually quite significant in terms of the execution of the action of walking. This is something else you’ll feel if you test it out at home:
Now, to be clear for change to be lasting, it needs to be regulated intrinsically.The instantaneous changes you see above will only be maintained if you work at it.
This means we can’t rely on this strapping forever.
The strapping acts as a catalyst for change because it increases the availability of contraction of the muscles (due to positioning of the sesamoid bones – more on this later), and when muscles can contract, this makes change a possibility, and it opens up the door for that change to be sustained.
So you can’t just strap it and sit down – you have to strap it and move. Use those feet.
This also goes for using toe-spacers – you have to make your practice active, otherwise they’ll only assist you for the time that you’re wearing them and there’ll be no adaptation.
To assist with the redevelopment of strength in the muscles within the feet, you should augment with a few minutes of manual therapy per day, at least initially. This improves blood flow to the area, and decreases trigger point prevalence. And trigger points decrease the ability of the muscle to engage.
You should then engage in strengthening work. I would recommend starting with strapping/toe spacers and progressing to without.
There are so many ways to do this but in particular I would focus on things like:picking up progressively smaller objects with your hallux alone (like, the other toes don’t help)short foot (see here if that doesn’t ring a bell) – you can also gently push the hallux down if you’re finding this movement too difficult to get any engagementBalance work with your heels raised!I did also put together a little paid video tutorial some time ago for more exercises for the feet if you prefer that kind of learning environment.
A note on bunions
If you have a bunion or a high degree of hallux valgus, it may be particularly difficult to get short-foot activation and recruitment of the intrinsic muscles of the foot. For an explanation of this, check out this video by Emily Splichal. This is all the more reason to use taping and spacers as a catalyst for engagement and change.
Also, the bump of a bunion is not necessarily going to go away with all this work outlined above. Yet, if you’re okay with the bump, a substantial portion of the symptoms and pain can be addressed using the above techniques and practices.
So a note on that, and this goes for everyone: all this stuff is less about aesthetics and more about function.
This means that if you simply want to get rid of the bump, I can’t help you.
But you should know that function is vastly more important than appearance.
Questions? Hit me up. Requests? Send me them too.
Oh, one more thing. You have to be consistent with this work, for it to actually work. Keep me updated on your progress, and keep chipping away. If you’ve got someone who would benefit from knowing this above, go ahead and forward it to them.