Physical Therapy for Non-Surgical Bunion Treatment

Orthopaedic & Spine Center

Jim Koske, PT, MPT

Bunions are one of the most common foot problems in America and one in three people will get at least one in their lifetime.  Women are affected disproportionately more than men, but we aren’t sure why.  We know that inherited foot issues and bad foot mechanics play a role in their formation as we walk and stand, but what about those tight, high-heeled, pointy toed shoes women sometimes wear?  They certainly may not help with foot and bunion pain, but to date there has been no causal link between those stylish stilettos and bunions.

If your foot and ankle specialist has diagnosed you with bunions, you may be given a script for Physical Therapy.  Exactly how, you may ask, is PT going to help this big, red, knobby ball on the side of my big toe joint get better?  In this article, I will discuss all the ways that a qualified Physical Therapist can help bunion sufferers with the pain, inflammation, swelling and loss of function that bunions may cause.

First, when a patient comes to see me, I am going to do a thorough physical examination and assessment.  I am going to ask the patient to walk, move their big toe and do some simple exercises that will demonstrate how much or how little range of motion, strength, and function they have in the MTP (metatarsophalangeal) joint, their toes and foot.  I am then going to develop a treatment plan based on their level of severity and what goals we hope to attain with treatment.  Because bunions are progressive, we can’t make them go away, but we can retard their becoming worse.

Decreasing inflammation is an area that we can work on first, because it will make everything else that we do easier and less painful.  We have many ways of doing this.  Your physician may have recommended NSAIDS, oral steroids or even a steroid injection to reduce the inflammation in the joint to give your body a jump start and to make PT less uncomfortable.  We utilize ice and cold packs to quickly reduce inflammation in the joint.  Other modalities, such as the use of an H-Wave machine, which runs high and low frequency current through the joint may be helpful.

I will also manually manipulate your foot, toes and big toe joint to stretch, increase flexibility and release adhesions or tightness.  Sometimes, this can be uncomfortable, but I promise we’ll get through it together and I won’t push you beyond your limits.

Patient education is very important so I will also teach you about your bunion, help you identify activities you are doing that can irritate your bunion, and even help you choose more accommodating footwear with larger toe boxes to ease bunion pain. 

Manual exercises are very important to improve range of motion and strength. Examples of these exercises are picking up a towel with your big toe repetitively or picking up marbles from the floor with your big toe and putting them in a basket. 

I can work with your doctor’s recommendations for taping, orthotics or splinting for your bunion as well, to relieve pain and pressure, as well as to decrease that inward big toe creep.  In more severe cases, you may have difficulty walking, so I may need to help you with training on an assistive device, such as a cane or walker.

As your condition improves, we will focus on functional training as well, based on your age, bunion severity, activity goals, lifestyle, work, etc.  It is important that you learn how to move carefully and safely, while compensating for the balance that can be lost by the deformity in your big toe and foot.