Bunions: From Early Signs to Treatment Paths

How can someone manage the early signs of bunions?

Bunions

A bunion, also known as hallux valgus, is a painful bone lump on the side of the big toe. Misalignment of the big toe is the most common cause of bunions. If you have bunions, you can notice redness, thicker skin, swelling, and pain around your big toe joint. You can’t stop a bunion from growing, but you can manage your symptoms as they get worse. Pain management tactics and various treatment options are among the first indicators of bunions. (MedlinePlus, 2024)

Early Signs That Can Be Seen

Bunions typically begin as small growths and do not usually cause noticeable problems. In the early stages of a bunion, you may experience the following symptoms around the metatarsophalangeal (MTP) joint, which joins the base of your big toe to the remainder of your foot. (American Academy of Orthopaedic Surgeons, 2022)

• Irritation
• Swelling, darkened epidermis
• Hard epidermis that has thickened
• A bony mass is present.
• Prominence in which the big toe moves toward the second toe or even under it
• Corns and calluses

Physical Symptoms at an Early Stage

Bunions may not be immediately visible, but they can cause discomfort even in the early stages. These are some early indicators that a bunion is getting bigger. (MedlinePlus, 2024)

• Pain in the foot and big toe
• When wearing tight, narrow-toed shoes or walking, this soreness is more apparent.
• Decreased movement of the big toe
• Tenderness
• Inflammation
• Swelling
• Stiffness
• Heat

Stages

Bunions are often progressive, meaning they tend to deteriorate over time. Complications may arise if you fail to prevent the growth of your bunions. The following symptoms characterize bunions in their advanced phases: (American Academy of Orthopaedic Surgeons, 2022)

• Chronic, severe pain situated in and around the MTP joint, as well as the sides and sole of your foot
• Bursitis is a condition that results in the formation of a fluid-filled cyst at the base of the big toe.
• Your big toe is bending toward and even crossing over your second toe.
• Overgrowth of bone along the side of your big toe
• Inability to accommodate your typical footwear
• Struggling to continue
• In hammer toe deformities, the middle of the second, third, or fourth toes bends upwards, approximating a claw or hammer.
• Hallux rigidus is a form of arthritis that affects the large toe.

Halt the Advancement

Bunions will become permanent once they have begun to develop. Nevertheless, there are a few methods to prevent them from deteriorating or resulting in additional complications. Which of the following are included (American Academy of Orthopaedic Surgeons, 2022)

• Not wearing shoes that don’t fit right or high heels
• Wearing orthopedic shoes or shoes that are wide, comfortable, have soft soles, and have low heels
• Putting spacers between your toes so they don’t scrape against each other
• Putting over-the-counter (OTC) pads consisting of felt, silicone, or foam over the bunion
• Stretching your calf muscles to help your joints line up better

Management of Pain

Ice packs and non-steroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen) or Advil, can be effective in alleviating bunion discomfort. Studies have also shown that Botox injections into the forefoot muscles may help alleviate pain. (Hurn, S. E., et al., 2022)

Non-surgical Treatment in the Early Stages

If your bunions continue to worsen after trying the steps mentioned above, you may need to consult a podiatrist (foot doctor) or another healthcare professional. A doctor may suggest

Orthotics, or foot orthoses

• Orthoses, also referred to as foot orthoses, are inserts specifically engineered to alleviate discomfort associated with bunions and prevent chafing.

Splints

• Bunion splints are orthotic devices that are typically worn at night and may assist in the realignment of your toes. (Aebischer, A. S., & Duff, S. 2020)

Physical Therapy

• A physical therapist can help you improve the alignment of your feet and joints by prescribing exercises and may carry out manual therapy to alleviate discomfort. (Hurn, S. E., et al., 2022)

Podiatrist

A podiatrist is a medical doctor (M.D.) who specializes in treating health problems that affect the feet, ankles, and lower legs. If you want help with your bunion issues, ask your doctor for a referral to a podiatrist. (American Podiatric Medical Association, 2025)

Chiropractic Treatment

Managing bunions from a chiropractor’s and nurse practitioner’s perspective involves addressing biomechanical issues, pain, inflammation, and potential progression of the condition. Below is an integrated approach based on insights from both professions, focusing on conservative, non-surgical strategies:

Chiropractor’s Perspective

Chiropractors focus on the musculoskeletal system, alignment, and biomechanics, which can play a significant role in bunion management. Their approach often emphasizes the role of foot function in the overall health of the body.

1. Foot and Lower Body Alignment:
   • Assessment: Chiropractors evaluate foot mechanics, gait, and posture to identify contributing factors, such as overpronation, flat feet, or pelvic imbalances.
   • Adjustments: Manual adjustments to the foot (e.g., mobilizing the tarsal or metatarsal bones) or other areas (such as the ankle, knee, hip, or spine) may improve alignment and reduce stress on the big toe joint.
   • Example: Correcting an overpronated foot can reduce medial stress on the hallux valgus (bunion).
2. Soft Tissue Therapy:
   • Techniques such as myofascial release or active release therapy can address tight or overworked muscles (e.g., the abductor hallucis) and fascia in the foot.
   • Benefit: Improves flexibility and reduces tension around the bunion, potentially slowing deformity progression.
3. Custom Orthotics or Footwear Advice:
   • Chiropractors may recommend custom orthotics to support the arch, stabilize the foot, and redistribute pressure away from the bunion.
   • Suggest wide-toe-box shoes to reduce compression on the big toe and promote natural foot movement.
4. Exercise and Rehabilitation:
   • Strengthening Exercises such as toe curls and marble pickups aim to improve the intrinsic foot muscles and enhance the mobility of the big toe.
   • Stretching: Stretches for the Achilles tendon, calf muscles, and plantar fascia to reduce strain on the forefoot.
   • Example: Toe spreader exercises or using toe spacers to encourage proper alignment.
5. Lifestyle and Ergonomic Advice:
   • Avoid wearing high heels or narrow shoes, as they can exacerbate bunions.
   • Weight management can help reduce pressure on the feet, as excess weight can aggravate symptoms.

Nurse Practitioner’s Perspective

Nurse practitioners (NPs) approach bunions from a primary care and medical management standpoint, focusing on symptom relief, patient education, and coordinating care.

1. Pain and Inflammation Management:
   • Medications: Recommend over-the-counter NSAIDs (e.g., ibuprofen) for pain and inflammation, with guidance on safe use.
   • Topical Treatments: Suggest topical anti-inflammatory gels or creams for localized relief.
   • Ice Therapy: Apply ice packs (15-20 minutes) to reduce swelling and discomfort, especially after prolonged periods of standing.
2. Patient Education and Self-Care:
   • Educate on bunion progression and the importance of early intervention.
   • Recommend a pad or a Moleskine to protect the bunion from friction and pressure in shoes.
   • Consider using nighttime splints or toe spacers to maintain alignment, although evidence on their efficacy is mixed.
3. Footwear and Orthotic Guidance:
   • Similar to chiropractors, NPs emphasize proper footwear (wide-toe-box, low-heel shoes) and may refer to a podiatrist or orthotist for custom orthotics.
   • Recommend avoiding activities that exacerbate symptoms, such as prolonged standing in tight shoes.
4. Referral and Coordination:
   • NPs may refer to a podiatrist or orthopedic specialist if conservative measures fail or if the bunion causes significant pain or deformity.
   • Coordinate care for patients with comorbidities (e.g., diabetes, arthritis) that complicate bunion management, ensuring foot health is prioritized to prevent ulcers or infections.
5. Monitoring and Preventive Care:
   • Conduct routine foot examinations to track the advancement of bunions, particularly in individuals with risk factors such as family history or connective tissue disorders.
   • Screen for related conditions (e.g., plantar fasciitis, hammertoes) that may worsen with bunions.

Integrated Approach

Combining chiropractic and NP perspectives creates a holistic plan:

• Initial Assessment: The nurse practitioner (NP) evaluates overall health, pain levels, and medical history, while the chiropractor assesses biomechanics and gait.
• Pain Relief: NPs guide on medications or ice therapy, while chiropractors provide manual therapy to reduce joint stress.
• Corrective Measures: Chiropractors prescribe exercises and orthotics, and NPs reinforce footwear and self-care strategies.
• Long-Term Management: Both monitor progress, with NPs coordinating referrals if needed and chiropractors optimizing foot function to prevent recurrence.

Evidence and Notes

• Studies suggest conservative measures (orthotics, exercises, proper footwear) can reduce pain and slow bunion progression in mild to moderate cases. However, severe cases may require surgical evaluation (Journal of Foot and Ankle Research, 2018).
• Toe spacers and splints may help alleviate symptoms, but they don’t correct the deformity in the long term (American Academy of Orthopaedic Surgeons).
• Both professionals emphasize the importance of patient compliance with footwear changes and exercises for optimal outcomes.

When to Seek Further Care

• If the patient’s pain persists despite conservative measures, it’s time to seek additional care.
• Significant deformity or difficulty walking.
• NPs can evaluate symptoms of infection, skin deterioration, or numbness to identify systemic problems, such as neuropathy.

For personalized care, consult a chiropractor for biomechanical assessment and a nurse practitioner for medical management. If needed, they can refer you to a podiatrist for specialized foot care.

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Dr. Jimenez is a nurse practitioner who combines medical knowledge with chiropractic care to address a wide range of health issues. The clinic has individualized care plans that include functional medicine, acupuncture, electroacupuncture, and sports medicine. The clinic focuses on strength, agility, and flexibility to help those with chronic pain syndromes and injuries. Patients of all ages and abilities can get personalized treatment and wellness outcomes with comprehensive care plans and in-person and virtual health coaching.

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