I never felt comfortable with my patients in the early part of my practice to tell them that my foot orthotics devices would help straighten their bunions. I was probably correct in that. However, my bunion patients would never go without their orthotic devices, for their stability and pain relief which is backed up with this paper. Bunion development weakens the medial column and orthotic devices with medial column support, metatarsal pads, occasional Morton’s extensions, etc, can make walking so much easier.
I have long talks with my bunion patients in stage 3 or 4 about surgery or not choosing surgery. I have seen too many stage 4 patients (maybe stage 5 or 6 if possible) barely able to move since their bunions got soooo bad. It is still a very individual decision. As with surgical or non-surgical choices with achilles ruptures, I will still treat them, and treat them for years I have.
The pain relief from custom orthotic devices is real in these patients. I tend to add one or two conservative treatments with each followup visit. I want to see them for yearly followup. The conservative measures include (and in no logical order):
- Toe Separators
- Yoga Toes
- Correct Toes
- Short Arc strengthening
- Bunion strengthening
- PT for lateral capsule flexibility
- Wide Shoes
- Proximal Padding for shoes that need it
- General foot strengthening to balance the weakness the bunion is creating
If you are unfamiliar with any of these, send me a response and I will try to clarify.
