Bunions (Hallux Valgus).
What is a bunion?
A bunion — medically termed hallux valgus — is a progressive deformity of the first metatarsophalangeal (MTP) joint, where the big toe deviates laterally toward the second toe while the first metatarsal head protrudes medially, creating the characteristic bony prominence on the inner side of the forefoot. The soft tissue structures around the joint adapt to this abnormal position over time, and the deformity becomes progressively self-perpetuating as the lateral pull of the toe flexors and extensors increases with greater deviation.
Bunions are one of the most common foot conditions in adults, affecting approximately 23% of adults aged 18 to 65 and up to 36% of those over 65. They are significantly more common in women than men — reflecting the contribution of narrow-toed and high-heeled footwear to deformity progression — though genetic predisposition is the primary underlying factor. Many people with bunions have a family history of the condition, and footwear primarily determines when and how rapidly a genetic predisposition expresses itself.
What causes bunions?
Bunions develop from the interaction of genetic predisposition and mechanical factors. The underlying structural predispositions include a hypermobile first ray (increased mobility at the first metatarsocuneiform joint), increased metatarsus primus varus (inward angulation of the first metatarsal), and ligamentous laxity — which is why bunions are more common in people with hypermobility and connective tissue disorders.
Footwear — particularly shoes with narrow toe boxes and high heels that crowd the forefoot and load the first MTP joint in an abducted position — accelerates deformity progression in those with underlying predisposition. It is the combination of genetic predisposition and mechanical environment that produces the clinical deformity, not footwear alone — which explains why not everyone who wears narrow shoes develops bunions, and why bunions occur in populations who habitually go barefoot.
Flat feet and excessive foot pronation increase the lateral deviation force on the first toe during the push-off phase of gait, contributing to progressive deformity. Inflammatory arthritis — particularly rheumatoid arthritis — accelerates bunion development through synovitis of the first MTP joint.
What are the symptoms?
Many bunions are asymptomatic — the deformity is visible and progressive but produces no pain or functional limitation. Symptomatic bunions produce medial forefoot pain at the bunion prominence, typically from pressure and friction with footwear. First MTP joint pain and stiffness — from the developing hallux rigidus (arthritis) that commonly accompanies advanced bunions — produces pain with push-off during walking. The displaced first toe creates secondary problems: the second toe is forced upward, developing a hammer or claw toe deformity. Forefoot load distribution is altered, contributing to metatarsalgia under the lesser metatarsal heads.
What can physiotherapy do — and what it cannot
While physiotherapy cannot reverse the deformity of the bunion itself, it can help improve the overall health of the foot, alleviate symptoms, and support rehabilitation after bunion surgery if needed.
This is an important and honest point. Physiotherapy and conservative management cannot correct the underlying bony malalignment — once the first metatarsal has deviated medially and the MTP joint has remodelled, only surgery can restore normal alignment. What conservative management can achieve is meaningful and clinically significant: managing pain, slowing the rate of deformity progression, maintaining first MTP joint mobility, and addressing the secondary consequences of the deformity.
How can physiotherapy help?
Intrinsic foot muscle strengthening — particularly the abductor hallucis, which runs along the medial aspect of the first toe and is the primary active restraint against hallux valgus progression — is the most clinically specific exercise for bunion management. Strengthening this muscle and the broader intrinsic foot musculature maintains the dynamic medial support of the first MTP joint and slows progression in flexible deformities. Towel scrunching, toe spreading and short foot exercises progressively build intrinsic foot strength.
First MTP joint mobilisation maintains the range of motion — particularly extension — that is essential for normal push-off mechanics during walking. Restricted first MTP extension compensates with excessive pronation and altered forefoot loading that accelerates both bunion progression and secondary metatarsalgia. Manual therapy addressing capsular and soft tissue restrictions in the first MTP joint is an important component.
Toe spacers and separators worn passively in the shoe maintain the first toe in a more neutral position and reduce the lateral deviation force during weight-bearing. They provide symptomatic relief and may slow progression when used consistently alongside active strengthening.
Footwear modification is the most impactful single intervention for symptom management — wide toe box shoes that accommodate the deformity without crowding or pressure on the prominence reduce pain dramatically and remove the most significant mechanical driver of progression. Custom orthotics addressing the underlying flat foot or pronation contributors reduce the lateral push-off force on the first MTP joint.
Physiotherapists design a customised exercise program to strengthen the muscles around the bunion and improve overall foot strength. Stronger muscles can provide better support to the foot's structure and reduce stress on the bunion.
For patients in whom conservative management is insufficient and bunion surgery — bunionectomy with first metatarsal osteotomy — is being considered or has been performed, structured post-surgical physiotherapy is important for restoration of normal gait mechanics, first MTP joint range and return to activity.
Clinical Pilates provides an environment for progressive foot and lower limb strengthening with attention to forefoot loading patterns. For patients where obesity is a contributing factor to forefoot overloading, exercise physiology through a Chronic Disease Management Plan addresses this alongside the foot management.
Our physiotherapists Eliane Machado, Emma Cameron and Bethany Kippen all have experience in foot conditions and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the gait and forefoot loading assessment underpinning bunion management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
A bunion — medically termed hallux valgus — is a progressive deformity of the first metatarsophalangeal (MTP) joint, where the big toe deviates laterally toward the second toe while the first metatarsal head protrudes medially, creating the characteristic bony prominence on the inner side of the forefoot. The soft tissue structures around the joint adapt to this abnormal position over time, and the deformity becomes progressively self-perpetuating as the lateral pull of the toe flexors and extensors increases with greater deviation.
Bunions are one of the most common foot conditions in adults, affecting approximately 23% of adults aged 18 to 65 and up to 36% of those over 65. They are significantly more common in women than men — reflecting the contribution of narrow-toed and high-heeled footwear to deformity progression — though genetic predisposition is the primary underlying factor. Many people with bunions have a family history of the condition, and footwear primarily determines when and how rapidly a genetic predisposition expresses itself.
What causes bunions?
Bunions develop from the interaction of genetic predisposition and mechanical factors. The underlying structural predispositions include a hypermobile first ray (increased mobility at the first metatarsocuneiform joint), increased metatarsus primus varus (inward angulation of the first metatarsal), and ligamentous laxity — which is why bunions are more common in people with hypermobility and connective tissue disorders.
Footwear — particularly shoes with narrow toe boxes and high heels that crowd the forefoot and load the first MTP joint in an abducted position — accelerates deformity progression in those with underlying predisposition. It is the combination of genetic predisposition and mechanical environment that produces the clinical deformity, not footwear alone — which explains why not everyone who wears narrow shoes develops bunions, and why bunions occur in populations who habitually go barefoot.
Flat feet and excessive foot pronation increase the lateral deviation force on the first toe during the push-off phase of gait, contributing to progressive deformity. Inflammatory arthritis — particularly rheumatoid arthritis — accelerates bunion development through synovitis of the first MTP joint.
What are the symptoms?
Many bunions are asymptomatic — the deformity is visible and progressive but produces no pain or functional limitation. Symptomatic bunions produce medial forefoot pain at the bunion prominence, typically from pressure and friction with footwear. First MTP joint pain and stiffness — from the developing hallux rigidus (arthritis) that commonly accompanies advanced bunions — produces pain with push-off during walking. The displaced first toe creates secondary problems: the second toe is forced upward, developing a hammer or claw toe deformity. Forefoot load distribution is altered, contributing to metatarsalgia under the lesser metatarsal heads.
What can physiotherapy do — and what it cannot
While physiotherapy cannot reverse the deformity of the bunion itself, it can help improve the overall health of the foot, alleviate symptoms, and support rehabilitation after bunion surgery if needed.
This is an important and honest point. Physiotherapy and conservative management cannot correct the underlying bony malalignment — once the first metatarsal has deviated medially and the MTP joint has remodelled, only surgery can restore normal alignment. What conservative management can achieve is meaningful and clinically significant: managing pain, slowing the rate of deformity progression, maintaining first MTP joint mobility, and addressing the secondary consequences of the deformity.
How can physiotherapy help?
Intrinsic foot muscle strengthening — particularly the abductor hallucis, which runs along the medial aspect of the first toe and is the primary active restraint against hallux valgus progression — is the most clinically specific exercise for bunion management. Strengthening this muscle and the broader intrinsic foot musculature maintains the dynamic medial support of the first MTP joint and slows progression in flexible deformities. Towel scrunching, toe spreading and short foot exercises progressively build intrinsic foot strength.
First MTP joint mobilisation maintains the range of motion — particularly extension — that is essential for normal push-off mechanics during walking. Restricted first MTP extension compensates with excessive pronation and altered forefoot loading that accelerates both bunion progression and secondary metatarsalgia. Manual therapy addressing capsular and soft tissue restrictions in the first MTP joint is an important component.
Toe spacers and separators worn passively in the shoe maintain the first toe in a more neutral position and reduce the lateral deviation force during weight-bearing. They provide symptomatic relief and may slow progression when used consistently alongside active strengthening.
Footwear modification is the most impactful single intervention for symptom management — wide toe box shoes that accommodate the deformity without crowding or pressure on the prominence reduce pain dramatically and remove the most significant mechanical driver of progression. Custom orthotics addressing the underlying flat foot or pronation contributors reduce the lateral push-off force on the first MTP joint.
Physiotherapists design a customised exercise program to strengthen the muscles around the bunion and improve overall foot strength. Stronger muscles can provide better support to the foot's structure and reduce stress on the bunion.
For patients in whom conservative management is insufficient and bunion surgery — bunionectomy with first metatarsal osteotomy — is being considered or has been performed, structured post-surgical physiotherapy is important for restoration of normal gait mechanics, first MTP joint range and return to activity.
Clinical Pilates provides an environment for progressive foot and lower limb strengthening with attention to forefoot loading patterns. For patients where obesity is a contributing factor to forefoot overloading, exercise physiology through a Chronic Disease Management Plan addresses this alongside the foot management.
Our physiotherapists Eliane Machado, Emma Cameron and Bethany Kippen all have experience in foot conditions and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the gait and forefoot loading assessment underpinning bunion management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
