Bunions – what are they and how can physio help?

A bunion is basically a ‘bone spur’ on the inside of the base of the big toe – the metatarsophalangeal joint to use the full name. It’s often accompanied by a slight deformity in the shape of the big toe where it points outwards – known as hallux valgus

What causes it?

The cause of bunions is often biomechanical and a bunion is one of a number of potential issues.

When you walk the foot is meant to roll slightly inwards in a controlled way. If this roll becomes too pronounced or isn’t controlled by the related muscles then it can lead to increased strain on the inside of the foot.

Over time this can result in a bunion but it can also lead to muscle or tendon strains, ligament sprains or plantar fasciitis.

What happens is that your toe is forced into what’s known as a valgus position and, to compensate, your body tries to add more bone to spread the load.

Are bunions always painful?

The good news is that bunions aren’t necessarily painful. They can sometimes be sore but more as a result of rubbing on shoes rather than the pain coming from the actual bunion. The problems tend to occur more as a result of the biomechanical issues that caused the bunion in the first place – so increased wear and tear in a joint leading to cartilage degeneration and subsequent inflammation.

Do I need to do anything if it’s not painful?

Opinion is divided on this one – but our advice is that it’s always worth taking seriously something that could be caused by a biomechanical issue.


Exercises such as this single leg squat can help, and when doing this you should really feel the muscles in the feet working as your toes grip the floor (as well as muscles further up the leg of course). Try to do this exercise very slowly and maintain a straight line down the outside of the body from your hip, through your knee and to the foot. It can be quite wobbly but don’t worry, this will work both your balance and your strength.

Painful bunions – what’s the answer?

Physio is a good starting point –  of course we would say that but it really is. Your physio can recommend exercises focussing on the issues that caused the problem in the first place, as well as techniques to offload the inflamed joint and improve movement. Acupuncture is also another option to provide some pain relief if it is flared up.

If physio doesn’t solve the problem then surgery is an option – but don’t underestimate the recovery. We’ve heard stories from people who have had the surgery talking others out of the procedure – usually because the problem has got to such an extreme point before hand.

However good ‘prehab’ can improve the outcomes of surgery after which your physio can refer you on when the timing is right. This video provides a good illustration of what the surgery involves.

As with everything on this blog, if you have any questions or concerns just drop us a line and we’ll do our best to help.


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