Bunions

Patients often describe for me their “ugly feet” and start talking about the bunions they have had for many years. They relate that they have had foot problems their whole life, and usually they do not mention the knee, lower back and neck problems they have also had for a good portion of their lives.  Bunions are not just a foot related issue, they are clues to a system wide movement strategy.

The foot is a great place to look when movement related problems arise. Even if we spend a good chunk of the day sitting, our feet spend a lot of time in contact with the ground, altering their shape throughout the day and throughout our lives. A bunion begins to form when our center of gravity moves really far forward. What does that mean? That means that as we take a step forward, we move our weight over our forefoot toward the toes. This is a normal part of gait, unless it happens too quickly. Should that occur at a rate that we can barely control, we will use the base of our big toe to slow the forward progression. The result after years of this strategy is a bunion.

Despite what you might find in an internet search, bunions are more than a bump residing near the big toe. It is one bone twisting in the opposite direction of another. Again, this happens during normal walking, but in the case of a bunion the twist never “untwists”, it becomes an ingrained pattern. That pattern is systemic, including multiple body regions that all move in similar ways to this part of the foot. Making changes at the foot is important, but making changes everywhere will have a bigger bang for the buck. Altering how the knees move, changing spine mechanics and developing new movement sensations may all contribute to improved mechanics at the foot.

Bunions, like so many other things, result from global movement strategies. They are an easy target because they are bold enough for us to see easily. Changing the shape of the foot, the sensations of moving and altering the mechanics elsewhere can all contribute to reducing the pressure at the forefoot and making lasting alterations.

Austin Ulrich, Physical Therapist