Many people think a Chiropractor is someone who you visit when you have back problems, but Chiropractors treat foot disorders as well. What is the connection between the two?
"Back or foot pain causes altered motions wich lead to more wear and tear in the joints over time. Good alignment and proper motion preserve joint health. Joints don't wear out; they age by injury, poor mechanics and off center motions. With proper alignment and normal compression, any joint can outlive our physical death by a long shot (one study, I believe, one the knee suggests over 250 years)."
Where do foot problems begin?
"In general, the area of injury creates a weak link. Biomechanically, foot problems often start in the pelvis. The classic example is when the pelvis on one side drops down placing stress over the knee creating pin-pointed pain. The knee is normally located just over the second toe. But instead, this downward pressure causes the knee to roll inward causing pronation, which then places excess pressure on the big toe joint area."
More specifically, what contributes to the development of bunions?
"There are two basics: Biomechanics and Gravitational Compression, and the combination of the two. For example, in gravitational compression, the weight of the body standing is just the weight of the body. However, while walking, 2.5 X our body weight is being forced onto the foot, and while running 3.5 X our body weight is forced onto the foot. Biomechanically, the interaction of heel stride, mid-stance and toe-off eventually go through the big toe. So if there is any instability and structural changes between the forces and alignment (such as lateral arch collapse), the big toe suffers"
"Sometimes callus on the foot show the area where stresses go and where pressure is avoided (the area next to the callus). Shoes that are too tight or too big can be a factor; in womens' shoes if the heels are more than 2 1/2 inches high, they will create more splaying of the fore foot and may lead to bunions."
What kind of effects do bunions have on a patient's gait and posture?
"Typical pain behavior which is 'avoidance'. Avoidance results in what I call a 'wobbling' movement that amplifies throughout a patient's gait and posture. So it is important to get the patient back to normal biomechanics as early as possible. For example, once a bunion is developed, it is usually tender to pressure. A patient may inadvertently avoid compression against the toe which will affect the entire biomechanical chain and posture. People with painful bunions are less likely to go for walks; their bunions have a limiting effect on their activity levels."
What treatments do y ou most frequently use when treating bunions and why?
"Muscle exercises. I work with the lateral muscle, the Adductor hallucis, located between the big toe and the second toe. This muscle atrophies because it is never used. However, it is very hard to exercise correction into the foot because of the gravitational compression that occurs on a daily basis. You pretty much have to train yourself to work this muscle.
I recommend stabilizers that are cast while standing, provide space around the affected area and treat the three arches: medical longitudinal, lateral arch, and transverse arch. I recommend semi –rigid stabilizers for their dynamic support and different types of compression.
I also like the Bunion Aid® Bunion Treatment Splint because it is mobile and introduces a corrective force not unlike a retainer for the teeth. Gradual force over time has a corrective effect if the brace is positioned correctly and the pressure of the brace to the toe is not irritating. I recommend to first wear the brace not weight-bearing, then increase the time gradually and wear it around the house.
Surgery is only the last resort. It is so invasive, and post-surgical trauma can have adverse affects itself."
People with bunions can mistakenly believe that if they just pull the big toe over laterally in one direction with either wedges, toe separators, or a rigid splint, that it will fix the bunion. Can you comment on this misperception?
"You can provide good support, stabilize the foot and make improvements, but it is very difficult to fix a bunion. From a biomechanical point of view, knees are associated with the fibularis muscles. These two muscles run alongside the lower leg and help flex the foot downward and upward at the outer ankle. If the knee is not moving correctly, the fibular cascades creating a diagonal movement, once again causing the foot to roll inward. Sometimes it is necessary to treat both the foot and the knee."
As I was reviewing the various bunion splints for our bunion splint buyer’s guide, it appears that most rigid splints only pull the big toe over laterally in one static position, while, Bunion Aid® offers an advantage during the straightening process because it pulls the big toe over laterally through the range of motion of the big toe joint. Is this true?
"I absolutely agree that this is a big advantage and that is why I have added Bunion Aid® as part of my bunion management regiment."