Crooked Toes are not Random

Misaligned toes and bunions are fairly common, but there are numerous misconceptions about this. Most fail to realize that their crooked, calloused feet and their ankle and foot pain like achilles tendonitis and plantar fasciitis go –ahem– hand in hand

My patients often look down at their feet and blame the problem on their mom. But bunions, spurring, and drifting and overlapping toes are not random occurances like a cyst or a plantar wart. These structural issues are the body’s typical response to mechanical forces. What’s inherited is not the bunion itself, but a faulty foot or lower leg structure and gait pattern that causes repeated abnormal strain through the entire kinetic chain.

“Okay so it’s not just a bunion. The bunion is there because something else is misaligned or not working properly.”

Before giving me a”Who cares?” eyeball roll, please consider the relevance to deciding the best way to treat a structural toe or foot problem. You could…

A. See callousing and bunions primarily as cosmetic issues that need to be treated at the spa or through surgery.

-Or-

B. See them as biomechanical problems in need of biomechanical correction or at least some supportive work away from the actual bunion.

For example, treatment for someone with a mild to moderate bunion and/or hallux valgus (first toe migration) may include:

1. Placing a splint or spacer between the first and second toes.
2. Appropriate width footwear that doesn’t perpetuate the sensitivity with pressure on the area.
3. Custom or semi-custom orthotics (shoe inserts) that correct for structural misalignment in the midfoot or rearfoot and allow for straighter forefoot (front of the foot) alignment as the patient rolls off the ball of the big toe.
4. Stretching and select strengthening of the foot, and more likely, the ankle and the hip, which promotes a better gait patter which unloads the part of the foot that’s taking a beating.
5. Gait training aimed at forming a “new groove” of walking that places more normal forces at the hip, knee, and foot and again, minimizing the biomechanical forces which cause the deformity.

Pain relievers help relieve pain and surgical correction is absolutely needed at times. But can you see how a toe splint and anti-inflammatory drugs is a short sighted fix for something that may be due to biomechanical forces all the way up at the hip? Orthotics and surgery are even of limited benefit if you walk like Donal Duck. Donald seriously needs some hip work.