Hallux Valgus

Core stability – for the foot?

We treat lots of patients with toe, foot, lower leg and knee symptoms, ranging from stiffness and pain to weakness and gait problems. There are many causes for these symptoms but weak leg and foot musculature are almost always an underlying cause.

Evolution usually has a solution for modern health problems. We now know that we should allow our children to play outdoors and mess around in the dirt because it improves their gut biome, and their long-term health outcomes. Evolutionary relevance? We evolved living outdoors and in caves, at one with the dirt and the billions of microorganisms contained in it so we had to thrive on it to evolve — and as it happens, without it, we don’t thrive.

So, what’s that got to do with our feet? We evolved barefoot in Africa. We had to thrive barefoot. Modern human foot structure is designed for tree-climbing as well as long-distance running — it has springs in the plantar aponeurosis, Achilles tendon and spring ligaments (all absent in apes and Australopithecus) as well as mid-stance flattening of the longitudinal foot arch to cushion foot impact and store recoverable strain energy in the elastic tissues.

Unlike most mammals specialised for running we retain substantial intrinsic foot musculature. Uniquely, as two-legged runners, we can control our balance during single leg support as our foot is intrinsically strong as well as mobile. Intrinsic foot muscles are most recruited when running, but also when walking with a load – which may account for our transformation to modern human form (and our ability to walk out of Africa – carrying our things and children with us).

Thus, in most shoes, whether comfortable, arch-support cushioned trainers or beautiful leather brogues, we load our feet inefficiently and fundamentally weaken our intrinsic foot musculature causing problems such as fallen arches (pes planus), pronation, and hallux valgus (sometimes commonly termed bunion).

How did this happen? We migrated north out of Africa and started wrapping our feet up for warmth. And by binding our feet, we reduce their healthy alignment.

Hallux valgus is a positional deformity of the big toe in which the toe deviates toward the other toes and risks triggering the development of a bunion (which can become painful, red and inflamed further worsening your gait and triggering other areas of pain).

Pronation describes the rolled-in position characteristic of weak medial arch muscles.

Flat foot describes the loss of the recoil position and the healthy arched shape of a relaxed foot. 

The role of physiotherapy and osteopathy in hallux valgus, pronation and pes planus (flatfoot)

Physiotherapists and osteopaths play an important role in the management and treatment of foot conditions. Here are some key ways in which we can help:

Diagnosis and prognosis

We can evaluate your foot be it hallux valgus, pes planus, pronation or other problems (e.g. osteoarthritis, hallux rigidus and tendonitis) and assess the root cause and halt any progression. We can provide guidance on proper footwear selection, foot care, and exercises that can be done at home to manage the condition effectively.

Pain management

We have a wide range of techniques such as manual therapy, massage, ice therapy and therapeutic ultrasound to reduce symptoms associated with pain and inflammation of toe, foot and ankle joints, muscles and tendons. We can advise on footwear modifications and/or orthotics to temporarily reduce pressure on the affected areas.

Strengthening exercises

Our physiotherapists and osteopaths can create customised exercise programs to strengthen your foot and leg muscles. Strengthening these muscles can help to stabilise the joints and prevent further deformity. These exercises may include toe curls, toe spreads, and ankle strengthening exercises as well as short foot exercises.

Research shows that performing the ‘short foot’ or ‘foot doming’ exercise which activates adductor hallucis (rather than the traditional toe curls) can improve flat arches (as measured by navicular bone drop and arch height index) and balance. Progressions from sitting to standing, single-leg standing, squats and hops will help manage hallux valgus, pes planus and pronation.

Stretching and mobilization

Our physiotherapists and osteopaths use stretching and mobilisation techniques to improve your joint mobility and flexibility which facilitates full contraction of intrinsic foot musculature. These exercises help to maintain the range of motion in the affected joint, reduce stiffness and improve the condition of your muscles and ligaments.

Gait analysis and correction

We can analyse how you walk (gait analysis) and identify any abnormal movement patterns that may contribute to the development or progression of hallux valgus, flat foot and pronation. We then provide guidance on corrective measures, such as modifying your walking or running technique, and your shoes (such as moving to thin socks to facilitate adductor hallucis contraction, gradual move to barefoot shoes or five-finger shoes) to strengthen the affected foot as well as preventing problems from developing in the non-affected foot.

In conclusion

Several of our practitioners wear Barefoot shoes and recommend Five-finger shoes. Others do strength training barefoot to improve foot strength (in the same way that training with weights improves your grip strength as well as your shoulder and hip strength). Prevention, early intervention and proactive management of foot and lower leg problems improve your ability to exercise, your balance and keep you pain-free allowing you to live your life to its fullest.