Monday, August 23, 2010

Bunions - Hallus Abductor Valgus – Part 4

Using Exercise to Treat Bunions
Exercise is an essential component in the treatment of bunions, it should not be optional. Soft-tissue therapy without exercise can only achieve a certain level of results, and the probability of the bunion returning becomes very high. Just as the kinetic chain must be considered when determining treatment therapy (ART, Graston, Massage, etc.), the kinetic chain must also be evaluated to identify weak links which can be strengthened through exercises. For example, it has been well established that weak hip muscles are directly related to an increase in abnormal foot pronation, and abnormal pronation has been shown to accelerate the formation of bunions. In such cases, to prevent a reoccurrence of the bunion, you need to do exercises to strengthen and correct the weak hip muscle.

The following are examples of some of the exercises that we prescribe for our patients. (This is not a complete exercise protocol for bunion treatment.) At our clinic, the exercise routines are customized to treat weak links in each patient’s kinetic chain. For more information about specific exercise routines, see .

Exercise Examples:
· Strengthening the feet
o Exercise #1: Sit down, with your feet flat on floor, and keeping your heels planted on the ground throughout the exercise. Now raise just your toes off the ground (as far up as you can) while keeping your mid-foot on the ground. Maintain the “toes up” position for 15 seconds with maximum tension, then bring your toes down. Repeat 5 to 10 times.
o Exercise #2: Sit in a chair with your toes on the edge of a towel. Flex and curl your toes to grasp the towel and pull it under your toes. Repeat 5 to 10 times.
· Stretching and mobilizing your foot: Keeping your toes mobile and flexible will help to reduce pain.
o Exercise #1: Sit on a chair, and cross your foot over your knee. Grasp the heel of foot with one hand; grasp your big toe with the other hand. Rotate and stretch your big toe in all directions (do not overstress the joint). At end-range, hold the stretch for 10 to 15 seconds. Repeat this procedure several times in all directions.
o Exercise #2: Stand upright, and wrap an exercise band around both big toes. Move your feet apart until your toes are straightened (keeping the elastic band taut between your feet), then hold this straightened position for several minutes. Repeat several times.
Supportive Aids:
· Orthotics – As mentioned earlier, excessive pronation can be a contributing factor in the formation of bunions. Custom fit orthotics can help stabilize the arch of the foot and reduce or eliminate excessive pronation or supination.
· Taping, bunion pads, toe spacers, and night splints can help to properly position your toes and reduce pain.
In most cases surgery is not necessary for the treatment of bunions. Conservative treatment can be very successful in the treatment of bunions, but you must ensure that your selected practitioner has a good understanding of anatomy, biomechanics, and the various factors causing bunion formation.

If you would like more information or to purchase our books please go to . 

If you would like information about our clinic in Calgary Alberta please go to


1. Brodsky JW, Beischer AD, Robinson AH, et al. Surgery for hallux valgus with proximal crescentic osteotomy causes variable postoperative pressure patterns. Clin Orthop Relat Res. Feb 2006;443:280-6.
2. Frey C, Thompson F, Smith J, et al. American Orthopaedic Foot and Ankle Society women's shoe survey. Foot Ankle. Feb 1993;14(2):78-81. .
3. Hart ES, deAsla RJ, Grottkau BE. Current concepts in the treatment of hallux valgus. Orthop Nurs. Sep-Oct 2008;27(5):274-80; quiz 281-2.
4. Kennedy JG, Collumbier JA. Bunions in dancers. Clin Sports Med. Apr 2008;27(2):321-8.
5. Mann RA, Coughlin MJ. Adult hallux valgus. In: Mann RA, Coughlin MJ, eds. Surgery of the Foot and Ankle. 6th ed. St. Louis, Mo:. Mosby;1993:167-296.
6. Sammarco VJ, Nichols R. Orthotic management for disorders of the hallux. Foot Ankle Clin. Mar 2005;10(1):191-209.


  1. Dr. Abelson,

    I have enjoyed the review. You've definitely brought some good things into perspective. One thing that we've had a lot of success with is assessing and treating more superior/proximal segments. Like eliminating the anterior weightshift caused by elevated heeled shoes, dysfunction at the cervical spine and the hips can lead to a similar weight bearing pattern and perpetuate HABV and the local tissue changes you discuss. We also have had success with teaching the CNS to defend hip rotational mobility and reduce shear on the foot via a more proximal strategy.

    Keep up the excellent writing.

    Carson Boddicker

  2. Thanks for the comments, you make some very good points. Addressing the overall weight stift is extremely important in numerous conditions. All the best...