A bunion is an enlargement around the base of your big toe. It’s caused when your big toe angles in towards the second toe. It may not cause you any problems, but it can become very painful around the base of the big toe. It can also begin to affect the alignment of your other toes. This can make running, walking and other weight-bearing activities very painful.
Bunions can be genetic. They can also be caused by your gait, if you put more pressure on the inside of your big toe when you run or walk. They can also be caused by narrow or pointy shoes that squash the big toe inwards.
If you get treatment for your bunion before the change in the toe is too severe, we can help you improve the alignment of your joint which can help reduce the pain. Changing your gait can also make a difference, and we can analyse your walking and running then create a strengthening and stretching programme to help with gait control and foot strength. Manual therapy can also help improve the flexibility in your muscles and joint. We may refer you to a podiatrist if we think that will help. In some cases, when the bunion is severe, you may need bunion surgery.
We’ll usually treat you for a bunion over 3 to 6 months, depending on how much your gait needs to change and what activities you want to return to doing.
The most common bunion surgeries are a first metatarsophalangeal osteotomy, a cheilectomy or a chevron osteotomy. Your surgeon will advise you on the most appropriate surgery. It could be open surgery or keyhole, depending on what needs to be done. If your bunion has affected other toes you may also need other procedures performed at the same time so that your foot can function normally.
Through physiotherapy, we’ll help you regain your full range of movement in the toe. An important part of your post-surgery rehabilitation will be gait re-education, making sure you can walk or run without putting excessive weight on the inside of the foot. We’ll give you stretching and strengthening exercises to correct any muscle weaknesses that caused the bunion to form in the first place. We can also advise you on appropriate footwear for the activities that you want to do.
The average recovery time after bunion surgery is 3 months for normal activities, and 6 months to return to running or doing other sport. Even after 6 months you may still have some swelling around the operation site, but it will be significantly less than immediately after the surgery.
Read our article on Preparing for bunion surgery
A broken toe could involve a fracture of a phalanx (the bones in the toes themselves), or of a metatarsal (the bones in the main part of foot that form the joint at the base of each toe). The bone that is fractured will determine what treatment is required.
From bumping your toe against something, to having it stepped on, or having a heavy object dropped on your foot, there are countless causes of broken toes.
Typically, if there's a fracture in your phalanx this is treated by taping the fractured toe to the toe next to it, or by putting you in a short Aircast boot or plaster shoe to immobilise the toe. If you’ve fractured a metatarsal and it has displaced and they're unable to realign it, you may need surgery to insert a pin and plate to keep the broken ends in line until the bone can heal. If it’s not displaced, you will be put in a short Aircast boot or plaster boot for 6 weeks.
Usually, you can walk bearing your full weight with a fractured toe, and you have localised pain and swelling to the fractured site. After 6 weeks, if the bone has healed well, you can remove the boot and walk normally. You may have some stiffness in the foot which can cause some discomfort when walking or running. In this case, a short course of physiotherapy can improve your range of movement and help you regain full strength in the muscles. Muscles in the foot and calf can become weak due to having been immobilised and your physio will also assess your gait and give you helpful tips to regain a normal gait pattern so that you can get back to running or other activities without causing any further problems.
Typically you should regain your full range within 6 weeks of coming out of the Aircast boot or cast. However, it can take up to six months to regain full muscle strength.
Morton's neuroma is when the nerve, typically between the second and third toe, becomes inflamed, resulting in pain to that area. This condition will be diagnosed with an ultrasound or MRI scan.
Morton's neuroma is when the nerve, typically between the second and third toe, becomes inflamed resulting in pain to that area.
This condition will initially be treated conservatively with physiotherapy to help improve flexibility between the metatarsal joints around the neuroma, but also to build up the strength in the intrinsic muscles of your feet to avoid excessive tightness in the foot.
Physiotherapy can also help manage this and improve the flexibility in your foot with soft tissue release whilst you are still building up your muscles. We can also analyse your gait and potentially give you pointers of how you can change your gait to avoid compressing the Morton’s neuroma.
Toe separators to use when you are non-weight bearing or at night can help relieve your pain, and it may be helpful to see a podiatrist who can advise you on devices that could change your foot position during weight-bearing and walking to decrease compression of the affected nerve.
Morton’s neuroma is a condition that needs to be managed long-term.
Metatarsalgia causes a sharp, aching and burning pain in the ball of your foot that is worse when standing, running or bending your toes. You may find it particularly difficult to walk with bare feet on hard surfaces if you have metatarsalgia.
Metatarsalgia is caused by overuse, with the foot being overloaded.
With metatarsalgia, you should initially rest your foot to let the irritation to settle. Once it has, we’ll look at the footwear that you're using to make sure it's supporting your foot when walking and running. We’ll also look at whether you need cushioned footwear indoors, especially when walking on hard surfaces. It may also be worth seeing a podiatrist to have an insole or metatarsal pad produced to cushion and support your forefoot.
With regard to physiotherapy, we’ll look at mobility in that joint, your gait pattern, and strength in your foot and will address problems with soft tissue release, muscle strengthening exercises and gait re-education.
Metatarsalgia is a condition that needs to be managed long-term.
With osteoarthritis, the affected toe joint will be painful and may be red and inflamed. It may be worse after you have done a lot of exercise or been on your feet for a long period of time.
Osteoarthritis is typically caused by normal ageing process, and it will be the soft tissue surrounding the joints that will be inflamed and causing pain.
With osteoarthritis, it's about managing the pain by reducing the inflammation around the joint and then strengthening the muscles. We will look at mobility and strength in your feet and provide you with relevant exercises to improve your range of movement, strength and control. We can also perform soft tissue release if there's tightness restricting the range of movement in your toe.
Osteoarthritis is a condition that needs to be managed long-term.
Painful toes can be caused by osteoarthritis, metatarsalgia, gout or Morton's neuroma. These conditions will be diagnosed with an X-ray, ultrasound or MRI scan, and for gout also with a blood test. With all of these conditions, you’ll have pain in or around the toe joint that is affected.
With gout this will also have excessive swelling and redness in the feet and sometimes into your calf. Metatarsalgia causes a sharp, aching and burning pain in the ball of your foot that is worse when standing, running or bending your toes.
Flat foot reconstruction and tibialis posterior tendon reconstruction are the same surgery. This procedure is done to regain the inside arch of your foot. The surgery consists of a tendon transfer, using the flexor hallucis longus tendon to support the medial arch, as well as an osteotomy – where a bone is cut, moved and pinned into the new location to provide a more neutral foot position and improve the medial arch.
This surgery is usually done if your arch has flattened because of a tendon injury, or you are experiencing a progressive flattening of the foot. Typically, it will be just on one side. It is not done for naturally flat feet.
After the surgery, you'll be put into a plaster cast for 2 to 6 weeks, and then into an Aircast boot for 4 to 6 weeks. The length of time will depend on your surgeon. After this, some surgeons will be happy for you to wean yourself out of the boot as you feel comfortable, while others will want you to wear a brace to provide arch support. You will be advised to start physiotherapy either at 2 or 6 weeks post-op, depending on your surgeon’s protocol.
Physiotherapy will normally begin with gradually regaining full range of movement in the foot and ankle and increasing strength, especially around the medial arch. You will be non-weight-bearing to begin with, and will gradually increase to full weight-bearing according to your surgeon’s protocol. During the partial weight-bearing stage we will encourage hydrotherapy to help with strengthening and gait re-education, as the buoyancy of the water will support your weight. As you move towards a full weight-bearing, we will progress to exercises on land with a graduated strengthening programme that will reinforce a correct gait pattern.
Your recovery will take around a year. Your goals and the activities you want to return to will determine how long you’ll need physiotherapy for.
Read our article on Preparing for surgery
Heel pain is often caused by plantar fasciitis. You’ll feel pain in your heel, predominantly on the inside of the foot. It can radiate into the arch of your foot.It can be painful standing or walking, with the pain subsiding as you get into your stride. You’ll usually only have it in one foot, but it may be in both.
Plantar fasciitis is caused by tight calves and a flattening of the arch of your foot. This increases the tension and irritation around your heel. Changes in your calf or arch are usually caused by a weakness or increased use of these muscles, or by the degeneration of the plantar fascia. We often see plantar fasciitis in long-distance runners, and in non-athletes with a high BMI.
Treatment often includes soft tissue massage to reduce the tightness in your calf. To provide short-term relief, we may tape the arch, recommend you are assessed for orthotics and provide you with a stretching regime and ideas on how to adapt the activities you like to do.
This isn’t a long-term solution though, and we’ll give you strengthening exercises for the arch of your foot and calf that will gradually increase the loading on the fascia. This will lengthen the muscles and increase the flexibility of your foot. We’ll also assess your gait and running style and provide you with gait re-education to ensure you’re not overloading the inside of your heel and that you’re making full use of your foot’s mobility. Our physiotherapists will also recommend you track your sleep, activity recovery and diet to improve overall condition.
It can take from 6 weeks to 3 months for the symptoms of plantar fasciitis to significantly improve. To get back to the level of activity that caused the problem, it can take up to a full year.
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