Foot Pain Relief: Help for Bunions and Neuromas

Results from a systematic literature review suggest that women experience foot pain more than men, and that the most common site of pain are the toes and the forefoot, AND that two-thirds of the population studied described moderate disability for daily living.   You can't walk very far if you feel like you have a pebble in your shoe, or every time you take a step you feel burning pain or tingling at the base of your toes.
A bunion occurs from pressure at the side of the big toe (hallux).  This pressure shifts the big toe toward the others and the joint can become swollen, sore and enlarged.
A neuroma occurs at the bottom of the foot typically under the 3rd and 4th toes.  The pressure at the forefoot irritates the plantar nerve and the tissue around the nerve can become dense and hard.  Because the nerve is irritated, people may experience burning, tingling, or numbness between the toes and foot.

What contributes to bunions and neuromas?

Footwear

Footwear:  The pic above shows a few shoe styles.  Each of these shoes have a very narrow toe box (typical of a women's shoe) which crunches all of the toes together. Most shoes have at least an inch heel, and high heels have a good 3 inches.  The height of the heel pitches the weight forward onto the forefoot, creating excessive load which can lead to nerve irritation, inflammation and tissue changes.
Forefoot Loading:  The pic on the right demonstrates 2 different ways to stand.  It is very common to see the pelvis thrust forward as in the 1st pic.  Notice that weight is shifted onto the forefoot.  The 2nd pic demonstrates neutral stand with the weight distributed toward the heel.

Forefoot loading

Forefoot loading creates excessive pressures that lead to nerve irritation, inflammation and tissue changes.

Simple Steps to Eliminate Foot Pain

1.  Take a piece of blank paper.  Stand barefoot on the paper and outline your foot with a pen.  Take this paper to your closet and compare the width of your shoes to the outline.  Don't wear the shoes where you can't fit your toes in the toe box, and the outline extends beyond the shoe.  Notice that the shoe sits inside of the outline in some places; don't wear these shoes!  Find shoes that do not have a heel.  If you are used to wearing a higher heel you will need to gradually transition to lower heels so your tissues have time to adapt (give yourself 4-6 wks before you transition for each .5 to 1 inch).
2.   Learn how to stand in alignment.  See pic above. Or read this blog.
3.   Wear toe spacers.  Yes, you should be able to see space between your toes!  There are many products on the market. These are my favorite: Correct Toes.  Cool thing about these is that you can wear them in your shoes!  Very comfortable (but you have to have a wide enough toe box in your shoe). If you have a bunion you may want to test to see if this will be comfortable for you before purchase: take your big toe and pull it away from your other toes as far as you can, and then lift it up.  If there is discomfort in the joint then your toe is probably compressed, and it would be good for you to see me, or your local PT (or chiro, osteo, etc) to work with you.

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Exercise your feet

Interlace your fingers between your toes. Try to get your fingers all the way to the bottom. You can stretch your toes by pulling them down and back, or just hold your foot 1-2 minutes each side.

Manually separate your toes and hold in a stretch for a few seconds. Do this on all toes and both sides.

Stretch the big toe down and the second to up. Then stretch the second toe down and the third to up. Continue for all toes.

Reverse directions. Pull big toe back and second toe down. Complete all toes.

Hold onto the forefoot and pull each toe, then give a little twist to the left and to the right.

Bunion reducer: Sit or stand, place a small rubber ball between your big toe knuckles. Bring your heels together and place a rubber band (use the band that goes around broccoli or asparagus) around the middle of your big toes. Hold for 2-3 minutes. Now actively move your toes! Take the band off and stand hip width apart. Lift and spread your as far as you can and return. Repeat 10-20 times.

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.