Hallux valgus is a progressive foot deformity in which the first metatarsophalangeal (MTP) joint is affected and is often accompanied by significant functional disability and foot pain.
• Bunions are a widespread foot ailment that can be caused by a number of factors including
Excess weight gain,
Activity level, and
• Other less common causes of bunions include trauma to the
MTP joint (sprains, fractures, and nerve injuries),
Some studies report that bunions tend to occur ten times more frequently in women than in men, primarily as the result of wearing narrow, pointy, tight fitting, and/or high-heeled shoes over a significant period of time. Repetitive stresses to the foot can also cause bunions.
• Your big toe points toward your second toe, or your second toe overlaps your big toe
• A prominent bump on the inside of the MTP or big toe joint
• Pain on the inside of your foot at the big toe joint when wearing any kind of shoe
• Pain each time the big toe flexes when walking
• Redness, swelling , or thickening of the skin on the inside of the big toe joint
• Radiographic exmatination show the angle formed between longitudinal bisection of the 1st Metatarsal and proximal phalanx.
• A big toe position with an angle of up to 10° is still considered normal.
• A minor hallux valgus defect is 16-20°.
• A moderate hallux valgus deformity has a deviation of 16-40°.
• A severe hallux valgus deformity has a deviation of over 40°.
• Magnetic resonance imaging (MRI) will detect cartilage damage, trapped soft tissue and bone damage.
• Adjusted footwear with wider and deeper tip
• Increase extension of MTP joint
• Relieve weight-bearing stresses (orthosis)
• Sesamoid Mobilization:The physical therapist performs grade III joint mobilizations on the medial and lateral sesamoid of the affected first MPJ. One thumb is placed on the proximal aspect of the sesamoid and is used to apply a force from proximal to distal that causes the sesamoid to reach the end range of motion (distal glides). These are performed with large-amplitude rhythmic oscillations. No greater than 20° of movement of the MPJ should be allowed during the technique.
• Strengthening of peroneus longus
• Electrotherapy Modalities – Ultrasound, ice, electrical stimulation, MTJ mobilizations and exercises. This is more effective than physical therapy alone. The combination will result in a increase in ROM of the MTP joint, strength and function, and also a decrease in pain .
Pain is the main reason that patients seek treatment for a bunion. Inflammation is best eased using ice therapy, techniques (e.g. soft tissue massage, acupuncture, unloading taping techniques) or exercises that unload the inflamed structures. Anti-inflammatory medications may help. Orthotics can also be used to offload the bunion.
For Restoring the Normal Joint Of Motion –
• Joint mobilisation (abduction and flexion) and alignment techniques (between the first and the second metatarsal)
• Muscle and joint stretches
• Bunion splint or orthotics
• Bunion stretch and soft tissue release.
For Strenghting Of Muscles –
• Towel curls The patient spreads out a small towel on the floor, curling his/her toes around it and pulling the towel towards them.
• The ends of the band are either held by an assistant or secured against an immovable object (e.g. a table leg). The patient then dorsiflexes the ankle, pulling “towards their nose,” working against the resistance of the band.