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Bunions and Big Toe Pain: Here's What to Do...

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Bunions and Big Toe Pain: Here's What to Do...

As we cover the topic of bunions and foot health, I can honestly say I am guilty of not prioritizing this area enough early in my career. We commonly emphasize the glutes, quads, and core that it’s easy to overlook this pivotal area.

The foot consists of numerous bones, ligaments, muscles, and tendons which ultimately create our foundation and connection with the ground. Whether it’s due to genetics, gender, occupation, anatomy, or footwear, there can be structural changes over time which negatively affect the alignment and function of the foot. One in particular is the development of bunions or hallux valgus.

Bunions can be classified as normal (less than 15-degrees) , mild (less than 20-degrees), moderate (20-40 degrees), or severe (greater then 40-degrees) depending on the degree of angulation at the great toe. Ultimately, as the great toe begins to angle towards the lesser toes and a bony prominence forms at the metatarsal head, this is a bunion (see image below).

Recently, I came across an article called, “Foot Mobilization and Exercise Program Combined with Toe Separator Improves Outcomes in Women with Moderate Hallux Valgus at 1-Year Follow-Up” by Abdalbary et al (2018). This is what we’ll reference in this article which will hopefully allow you to address your bunions and great toe pain to restore overall foot health and function.

Bunions are worth addressing since they are accompanied with functional disability, foot pain, impaired balance, and high fall risk in older adults. I regularly evaluate the foot and toes when working with runners and athletes because it has a big impact on stabilization and propulsion during gait and running.

Although surgery may be the most common approach to remedy this structural abnormality, it can be costly and create complications since it disrupts the normal mechanics of the great toe metatarsophalangeal (MTP) joint. From a conservative standpoint, treatment is aimed at mobilizing the necessary joints and stretching to decrease the angle of the great toe and restoring alignment with it’s respective metatarsal bone, increasing strength of the surrounding musculature which holds the toe in a more aligned position, and retraining normal function of the foot in various movement patterns.

The study mentioned above had 56 women (28 in the treatment group and 28 in the control group) who were diagnosed with symptomatic moderate hallux valgus. All of the patients in the treatment group wore toe spreaders for a minimum of 8-hours per day and completed the recommended physical therapy program consisting of three sessions per week for 12-weeks.

The physical therapy program consisted of… 

  • Joint mobilizations: Targeting the metatarsophalangeal joints, 1st metatarsophalangeal Lisfranc, transverse tarsal, subtalar, and ankle joints
  • Stretching: Non-weight bearing achilles tendon stretch
  • Strengthening: Great toe flexion, abduction, and towel curls

As seen in the table below, there were significant improvements in many areas relating to pain, disability, and function of the great toe/foot immediately following the 12-weeks of physical therapy sessions which was also seen at the 1-year follow-up. That means a conservative approach, compared to no intervention at all, can be cost-effective and worthwhile in addressing big toe pain and bunions.

If you have a bunion or big toe pain and want to play your part in addressing this once and for all, below is a handful of exercises that are similar to what were prescribed in the study without the use of a trained physical therapist. Of course, I always recommend seeking the advice of a trained healthcare professional when dealing with pain. But these exercises could be your first step to seeing improvements when performed properly over a similar time period.

Passive Great Toe Abduction

Passive Great Toe Extension

Achilles Tendon/Calf Stretching

1st Metatarsophalangeal Isometric Flexion

1st Metatarsophalangeal Isometric Abduction

Towel Curls


With the improvements seen immediately post-treatment and at the 1-year follow-up, it provides hope that bunions and great toe pain can be improved with conservative treatment. Since surgery is a common strategy to address bunions in order to reduce pain and improve function, I highly recommend speaking with a trained healthcare provider sooner rather than later to determine what you can do to improve your situation. If you have any questions, fill out the formto contact me directly.

By: Garrett McLaughlin, MS, ATC, CSCS, ART

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