images-21 A bunion is a large bump on the side of the foot that develops at the base of the big toe when the toe deviates inward.  It is very common for a bunion to be swollen and inflamed, leading to foot pain.  Most commonly affected are women and older adults, although anyone can develop a bunion.  If left untreated the joint may enlarge, becoming stiff and painful.  This can lead to problems with getting shoes to fit as well as difficulty walking.  Physical Therapists can help individuals with bunions by improving the angle of the big toe, increasing muscle strength and walking mechanics, as well as reducing discomfort.



flickr_photo_of_bunion_and_xrayThere are several factors that can cause bunions.  Among them are:

  • Heredity
  • Shape of the foot
  • Flat arches
  • Excessive laxity in the joint at the base of the big toe
  • Arthritis

It is interesting to note that tight footwear has often been blamed for bunions, but recent studies suggest that footwear may not be a factor in their development.  However, wearing tight shoes may certainly irritate a bunion by rubbing on the tissue at the joint, causing more swelling and discomfort.



There is no relationship between the severity of a bunion and the symptoms experienced, so how a bunion feels varies with each individual.  Not all bunions are symptomatic; however, people with bunions describe mild to severe symptoms.  These can include:

  • Pain and inflammation in the joint of the big toe that increases with standing and walking.
  • A gradual increase in size of the bump on the side of the foot which can become swollen and lead to foot pain.
  • Pain with wearing shoes, sometimes making it very difficult to find comfortable or stylish footwear.
  • Increased difficulty walking, which can lead to changes in gait mechanics.
  • Changes in balance which can lead to an increased risk of falls, especially in older adults.
  • Crossing of the big toe (as well as lesser toes), leading to crowding and possibly additional deformities (and associated pain).
  • Decrease in quality of life as a result of foot pain.



The first thing your Physical Therapist will do is take a detailed medical history, including when the symptoms developed and how you are currently being affected.  Other things include:

  • Measuring your foot’s flexibility and range of motion
  • Testing strength of the foot and big toe
  • Measuring any swelling or deformity, and noting any tenderness around the foot and big toe.
  • Observation of walking mechanics, paying close attention to how you bear weight on the involved foot
  • Checking your footwear for proper fit, as well as wear patterns.



The goal of Physical Therapy is to decrease discomfort, improve the angle of the big toe, and increase muscle strength.  This is most often accomplished with pain management, therapeutic exercises, gait training, and education regarding proper footwear and self-care for management of symptoms.  Treatments will most likely include:

Manual Therapy–This includes hands-on treatment such as joint mobilization and/or soft tissue massage to help decrease pain and stiffness in the joint and surrounding soft tissue, as well as to improve range of motion and flexibility of the big toe, foot, and ankle.  This also includes helping to reposition the big toe, depending on the severity of the deformity.

Therapeutic Exercise–This will include range of motion and strengthening exercises to help improve the alignment of the big toe when standing, and to improve walking mechanics.

Balance Training–This will include functional standing and walking exercises to help improve balance during movement.

Symptom Management–This will be part of your home program to include such things as self-massage, use of ice/heat for inflammation/pain, and when to elevate your foot.  Also included would be recommendations for proper footwear.

Activity Training–As you regain strength and flexibility, your Physical Therapist will provide you with individual specific activity training based on your job, sport, or leisure activities.

images-19Orthotics and Other Devices–Recommendations may include foot orthotics, splints, or other assistive devices depending on your specific condition.  These may include:

  • Orthotics (custom arch supports) to help keep the foot and ankle in proper alignment when walking.
  • Splints and toe separators to help decrease pain and pressure on the big toe.
  • Assistive devices such as walkers, canes, or crutches to decrease pain and relieve stress on the joint while walking.



There is currently no evidence out there that bunions can be prevented, but you can certainly be proactive and prevent a problem from getting worse, possibly avoiding surgery.  This includes:

  • Wearing Proper Footwear–An obvious tip would be to avoid wearing shoes that are too tight and squeeze the toes together.  Getting shoes with a wider toe box will help to diminish the inward pressure of the big toe, as well as helping to keep the outside of the foot from rubbing against the shoe.
  • Using Splints/Orthotics–Studies indicate that wearing shoe inserts or orthotics can help to prevent the arch from flattening out during walking, thus reducing pressure on the big toe.


If you or someone you know is experiencing foot pain, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at to schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t delay–schedule now!