"Between The Toes" - Advanced Nursing Foot Care
Diagram of  Common Bunions of the footBunions
Bunions are a large bump on the side of the foot, just below the big toe joint.  Seen in the picture above as a structural bunion.  Medical term is called a Hallux Valgus.  The big toe gradually turns inward towards the second toe.  Symptoms include pain with walking,  difficulty fitting into shoes and painful calluses on the soles of the feet.  Bunions are caused by overpronation.  This means that when a person stands they tend to roll there foot inward on the joint of the big toe.  Over time this creates a deformity called a bunion. 
 Preventions include wearing lower heels when wearing high heels, commuting in comfy shoes, custom orthotics, avoid shoes that pinch or squish the toes together, minimize pain to the bunion area and seek professional assistance with your foot problems.
 You can also develope a bunion on the top of the great toe (head of the metatarsal joint).  This is call a Hallux Limitus/Rigidus. 
Early Symptoms/Diagnostic Signs (Hallux Limitus):
  •  Pain and stiffness in the big toe when it is pushed upwards, as occurs when we walk, run, squat, and stand on our toes.
  •  Swelling and inflammation of the joint, especially on the top of the joint.
  • Discomfort in the joint that occurs when the weather is damp and cold.
  •  A feeling of ""tightness"" in and around the joint.
Later Symptoms/Diagnostic Signs (Hallux Rigidus):
  • Pain in the joint that is almost constant. Can even be felt when resting and after the shoe has been removed.
  •  Crepitus, or a ""grinding"" feeling in the joint when the big toe is moved up and down.
  •  A bump, or ""hardness"" can be felt on the top of the joint. Eventually, this bump which is actually a bone spur, becomes large enough to be seen with the naked eye.
  •  Difficulty wearing shoes, especially high heels, due to the bone spur and stiffness of the big toe joint.
  •  Walking becomes so painful that we try to walk without bending the big toe. This can cause:
  •  Limping
  •  Pain in other parts of the foot, as we try to throw our weight off of the big toe on to the adjacent foot structures.  This causes us to try and limit bending of the great toe when we walk.
  • Pain in the knee, hip, and lower back due to changes in the way we walk.
. Weight gain due to lack of walking and exercise, because of this pains.
Self-Treatment or Prevention  This is most important when trying to prevent the devastating effects of Hallux Limitus and Rigidus. If this disease is not prevented or treated in its earliest stages, it may produce such debilitating pain and deformities that surgery will be required to allow the foot to function normally again.

Long Term Treatment
  •  Stabilizing the foot. When the foot is maintained in its normal, or neutral position, it cannot pronate and roll out. When pronation is controlled, the big toe no longer bears excessive weight. This reduces forceful and destructive compression of the cartilage in the big toe joint. Thus, the big toe joint remains healthy.
  • Supporting high arches in order to relieve excess pressure on the balls of the feet,
especially the big toe joint. When the big toe no longer must bear excessive amounts of
weight as it ""pushes"" us forward, the big toe joint cartilage is protected from
excessive compression and force. The result is a healthy joint cartilage, free of deterioration and tearing.
  •  Stabilizing the big toe, and preventing it from ""over-flexing,"" as it pushes us forward. This will help to reduce the excessive jamming back of the big toe into the joint cartilage. Without this jamming effect, the cartilage remains healthy and intact.
  •  Providing shock absorption for the foot. The arches of our feet are our body's main shock absorbers. As we take each step, the arch of the foot helps to absorb and disperse the tremendous force that happens when our foot strikes the ground.  This force can equal 3 to 7 times that of our body weight.  This also depends on if we are walking or running.  When the arch is higher than normal, shock absorption by the arch is reduced.  When this occurs, the big toe, ball, and heel of the foot, must absorb this shock. The effect on the big toe is to over-flex, or to be jammed back into the joint cartilage with excessive force, which may cause the cartilage to wear down prematurely and unevenly.
Orthotics are considered to be the "Gold-Standard" of medical treatment, especially in the prevention and early stages of Hallux Limitus/Rigidus.  Benifits of orthotics are:
Stabilize the foot by using uniquely placed medial wedges, deep heel cups, and "posts" (stabilizers). When the foot is stabilized, it is brought back to a neutral or normal alignment.
When the foot is in its normal alignment, pronation is reduced or completely corrected, and, the big toe is no longer forced to bear excessive body weight. This prevents abnormal wear and tear on the big toe cartilage, and helps to stop or prevent Hallux Limitus/Rigidus from occurring.
Provide the specific amount of arch support
that your foot requires.  Custom-made orthotics support not only the arch as a whole, but each individual bone and joint that forms the arch.
When the arch is properly supported, it is allowed to function in providing optimal shock absorption for the foot, especially to the big toe joint. This will reduce the wear and tear on the joint cartilage.
Stabilize the big toe
and limit its movement during the gait cycle. This is accomplished through the use of a uniquely placed ""stabilizer"" called a
Morton's Extension. It is embedded in our custom-made orthotics, and placed under the 1st metatarso-phalangeal joint and big toe. It is a semi-rigid platform, which is covered by a padded material to ensure comfort. This Extension limits the motion of the big toe joint, thus reducing or eliminating pain. It works in two ways:
. It reduces/or prevents the big toe from bending and pushing us forward as we walk or run.
.Its shape allows for a slight tilting of the forefoot that ""off-loads"" the weight from
the big toe to the remaining structures of the forefoot and toes. When this occurs, the
big toe is allowed to ""rest,"" while the orthotic itself, and the other foot structures take over the job of the big toe.
Reducing movement of the big toe, as well as the amount of weight it must bear results in a reduction or complete elimination of:
· Pain.
· Joint cartilage destruction.
· Bone spur formation around the big toe joint.
Immediate Treatment must be directed towards reducing the inflammation, swelling, and pain in the big toe and its joint, the 1 metatarso-phalangeal joint. In the very early stages of Hallux Limitus, the following self-help treatments may be effective:
  • Rest the foot by keeping weight off of it. Each time you take a step, the big toe joint is aggravated and abused. It cannot calm down if you do not keep weight off of the foot.
  • Shoes can help to protect the big toe joint if they have the following features:
  • A rigid sole. This will help to reduce bending of the big toe with each step that is taken.
  • A wide and deep toebox keeps pressure off of the big toe and swollen joint.
  • A flat shoe reduces compression and injury of the big toe joint cartilage. High heels and short shoes jam the big toe back in the joint with excessive force, causing destruction of the joint cartilage.
  • Proper length shoes will also go a long way in reducing jamming of the big toe into the joint cartilage.
  • Reduce pressure on the big toe joint. Use a soft gel pad to cushion the ball of the foot and reduce pressure on the big toe joint. 
  • Soaking the foot in warm water may help to soothe the inflamed and painful big toe joint. The soaking water must be comfortably warm and not hot, as hot water will usually cause discomfort, skin burns, and increased joint inflammation and swelling. Soaking for 10 to 15 minutes two or three times a day is usually suggested. If soaking increases pain, swelling, or inflammation, stop immediately.
  • Gentle massage with a topical pain reliever can help to provide comfort. By combining the pain relieving properties of a pain relieving rub  with gentle massage, pain, swelling, and inflammation can be reduced or eliminated.
If the pain becomes worse, the foot more swollen or inflamed, or if you think that you have a serious problem, see a doctor immediately.
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