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The Role of Night Splints in Treating Bunions

 

The effective treatment of bunions requires both time and patience, and there are often several steps and methods that need to be used in order to produce a satisfactory response. The use of night splits in treating bunions is often highly effective, as the splint is worn next to the skin and is used to straighten the ligament of the big toe and realign it into proper position.

Aside from stretching the muscles and tendons of the toe and forefoot the realignment of the mechanics of the foot will also likely reduce the pain and discomfort typically associated with bunion development, as this type of stretching relieves chronic pressure points and may help to reduce inflammation as well.

Night splints are most effective when introduced early on; like most gradual onset foot deformities involving ligaments and bone prevention is much easier than treating a condition after it has become acute. Splints are typically worn at night as they difficult to walk in and to use with shoes, but overnight usage also allows the splint to be worn for extended periods of time, which may be a factor in their effectiveness. While there are hybrid units available that allow for both night time and daytime use this type of device usually requires a wider fitting shoe if they are to be worn outside of the house.

As suggested earlier, night splints play one role in the overall treatment of bunions, and the use of other types of orthotic devices may be productive during typical daytime activities and while walking or standing for prolonged periods of time. There is no one ‘cure-all’ for bunions or bunion development but if treated early enough it appears that night splints can in fact play an important role in halting the progression of bunion development over time, particularly when used in tandem with other conservative treatments and lifestyle changes.

One of the most important considerations in the treatment and care of bunions is the prevention of deterioration that may lead to mandatory surgical intervention should the affliction become severe enough. While some patients may find the use of a night splint to be less than optimal it should be noted that surgical intervention is not always effective and comes with its own inconveniences and risks.

Fortunately, most night splints are now designed to be both adjustable and comfortable and are created with pressure-point padding and cushioned straps. Like most orthotic devices night splints should be properly worn and adjusted for maximum benefit and wear-ability.  Many patients will require input from a doctor or specialist when choosing an appropriate night splint and as much information as necessary should be provided.

It should be stressed to the patient that night splints are an effective part of an overall treatment plan but they are not a cure and should not be relied upon exclusively. The treatment of bunions is a long-term process that does not guarantee results, however, early intervention and consistent use of conservative treatments, including the use of orthotic devices, is an effective way to slow the progression of this debilitating condition.

View Bunion Night Splints

The Relationship between Bunions and Shoes

 

There is a direct link between foot health and foot wear. Shoes that fit well and provide proper support will promote healthy feet while ill-fitting shoes will have the opposite effect. Bunion development is a primary example of this relationship as their existence is often linked to ill-fitting footwear.

Because bunions can occur when too much pressure is applied to bones and ligaments of the great toe care must be taken that shoes allow the toes sufficient space during weight bearing activities, as insufficient space will force the toes inward, which can eventually lead to deformation and partial dislocation in the joints of the big toe as it continuously bends inward to accommodate the shape of the shoe.

Shoes that are constrictive in the toe are the most likely to cause problems, and this may occur if there is incorrect sizing or due to the design of the shoe. Many people frequently wear incorrectly sized shoes simply because they have always done so, and it is highly recommended that people suffering from bunions have their feet professionally measured and sized.

As far as design is concerned high heels and pointy-toed shoes are two of the biggest offenders. Shoes with pointy toes naturally restrict the amount of space that toes have, and even worse, the design actually forces the digits to bend painfully into the center of the foot, which is guaranteed to cause foot problems over time.

There are several major problems that occur with regular wearing of high heels, and bunions are one of the most common issues that develop over time. The angle of the shoes forces the toes into the box of the shoe, where movement is not only restricted but where pressure tends to build as well. This is one of the reasons why women develop bunions at approximately nine times the rate than men do.

This statistic is changing as fashion ideals change, however, and as pointy toed shoes have increased in popularity in men’s fashion the frequency with which men are afflicted with bunions has increased as well, as have other shoe-related issues such as hammertoe and generalized foot pain.

Fashion has become a major issue to podiatrists simply because the styles have become more extreme over the years; pointy shoes have become pointier and heels have gotten much higher. While the average heel height used to range from 1 inch to 2.5 inches 3 inches and higher has now become the standard, with more women wearing ‘ultra heels’ (6 inches or more) much more often than before.

This has caused a corresponding increase in foot and back problems, and also seems to have accelerated the development of foot deformities such as bunions. And while platform or wedged heels may be easier to walk in fashion has recently dictated that the gradation of the shoe be extreme, which means that excessive pressure is still placed on the foot. These type of shoes also often cause ‘hot spots’ to develop in the feet because they do not have a bendable arch or toe box, which causes unusual rigidity and pressure points to develop.

The best method for preventing bunions is to have your feet professionally measured, ensure the shoe bends moderately at the toes box and provides proper arch support, and if heels must be worn they should be ‘chunky’ and less than 2 inches high.

 

View Products to Treat Bunions

Slowing the Progression of Bunions through the Use of Orthotic Devices

 

Orthotic devices are medical constructs used to support and/or realign the lower limbs, and they are either purchased ‘over the counter’ or custom designed by a specialist. These devices have a variety of uses, one of them being the slowing of the progression of bunions through the realignment of bones and ligaments and the redistribution of pressures throughout the foot.

While orthotic devices cannot ‘cure’ bunions they can slow their development by treating the instability and mechanical deformities and/or dysfunctions that cause the bunion to develop in the first place. Orthotic devices also often provide relief from the discomfort frequently associated with this condition.

The only true ‘cure’ for bunions is surgical intervention, but this option is not without risks and complications, and is thus usually perceived as a last resort option, though orthotic devices are compulsory after any type of bunion surgery. However, all other treatment options are generally exhausted before surgery is even considered. Orthotic devices are generally very effective in the treatment of foot disorders as high quality devices compensate for sup-bar functioning of the foot by limiting abnormal movement and rotation throughout the limb.

Functional orthoses are used to control unorthodox positioning and movement in the foot during weight bearing activities, such as standing or walking. These devices also stabilize the mid-foot and heel; ‘normalize’ the mechanical motions of the lower limbs to a satisfying degree, and limit the amount of pronation that can occur during the gait cycle. This correction is crucial to effective, non-surgical treatment of bunions and while it is not a cure the correct use of orthotic devices for this purpose can help slow the progression of this condition, particularly if pressures within the big toe are effectively reduced.

While functional orthotics can minimize bunion development by effectively redistributing body weight so that the first metatarsal head is exposed to less pressure care should be taken that the shoe does not become ‘crowded’. If there is insufficient space in shoe due to the introduction of an othortic device propulsion of the foot may be limited and the first ray of the foot may become ‘blocked’.

Like most foot problems the treatment of bunions and the effective use of orthotic devices to slow their development may depend on early intervention, as using a device may be more effective when the intermetatarsal angle is not yet notably developed. If the bunion has progressed beyond a certain point surgical intervention will almost inevitably be required, however, the introduction of conservative treatment in the earlier stages is almost sure to be effective in reducing the severity of the affliction.

It is also worth noting that using custom orthotic devices may be more effective in slowing down bunion development than the use of ‘ready-made’ orthotic devices as varying levels of flexibility throughout the foot may be required to maximize tension distribution. It sometimes happens that the materials and structure of an OTC orthotic device does not match the needs of the patient, so while orhotic devices may be very effective in slowing down the progression of bunions it’s important to note that not all devices are equally effective.

View Orthotics to Treat Bunions

Secondary Conditions Associated with Bunions

 

Bunions generally cause a host of primary issues in the lower limbs, but they can also cause several secondary conditions to develop as well due to the altered structure and condition of the foot. Whenever an issue develops in one area of the foot it is sure to affect the entire area to varying degrees.

Exterior secondary conditions generally include corns and calluses, which may occur as a result of unstable pressure points caused by hallus abducto valgus, which is essentially caused by a shifting of the bones at the front of the foot, primarily in the joints of the first metatarsal.  The most common complaint due to secondary conditions is discomfort caused by the development of corns. This type of secondary pathology can often be treated using over the counter products, but care should be taken to address the underlying issue as well; namely, the fact that a bunion has developed and will likely grow progressively worse.

Bunions often occur because there are structural changes in the foot due to the wearing of ill-fitting or constrictive shoes or inherited foot abnormalities, and secondary conditions will often occur as the foot tries to protect itself and/or compensate for these changes.

Unfortunately, secondary conditions often take the form of more difficult to treat afflictions, and the following issues are both common and more complicated to treat:

Hammertoe

Hammertoe is a painful condition in which the end of a toe is forced downward because the middle joint has contracted in a bent position. While it can occur in any toe the second toe is most vulnerable to being stricken. Wearing high heels can cause both bunions and hammertoe to occur, and the existence of a bunion alone—even if proper footwear is being worn—is enough to cause pressure imbalances that lead to the development of hammertoe.

Osteoarthritis

Osteoarthritis is often referred to as ‘wear and tear’ arthritis, and feet that have bunions have often experienced a great deal of wear and tear. This type of inflammatory disease will not ‘spread’ to other joints the way that other types of arthritis will. This is not to suggest that it is any less serious than other types of inflammatory disease. Not only is osteoarthritis painful but it may in turn lead to reduced mobility around the big toe and bunion as well as the development of bone spurs around the afflicted joint.

If the spurs around the joint become excessively pronounced it is referred to as a ‘dorsal’ bunion, which is not the same as ‘hallux valgus’, although both types of bunion may affect the same joint.

Metatarsalgia

This is a very general term that refers to pain in the front part of the underside of the foot near the metatarsal bones, which is located before the toes begin. It is frequently referred to as the ‘ball’ of the foot. Metatarsalgia generally occurs as a symptom to another problem and not as a problem itself. The existence of a bunion not only places excessive pressure on the underside of the foot in general but places particular stresses on the ball of the foot particularly, which often leads to the development of metatarsalgia.

Early treatment of bunions is important for effective treatment of both primary and secondary conditions associated with this type of deformity.

Bunion Development in Young People

 

Bunions are generally associated with people older than 25 years of age and with good reason; this type of foot deformity is usually progressive and is the result of years of excessive pressures. Juvenile bunions are not unheard of however, and those afflicted usually range between 11 and 14 years of age. Children under the age of 10 are generally asymptomatic.
There is very little agreement concerning the etiology and treatment of bunions in the juvenile population. While some specialists insist that this condition is acquired in the formative years other specialists believe that this deformity occurs due to the malleable and unformed nature of bone tissues in people younger than 20 years old. And it is debatable whether juvenile bunions are merely a stage in the development of ‘adult’ bunion development or whether it is a separate condition that can lead to particular deformities in the developing foot bones of children and adolescents.

 

There are, in fact, several differences in the bunions typically found in juveniles when compared with adult deformities. Juveniles display less marked valgus rotation of the hallux, less incidence of arthritis in the first metatarsal joint, less incidence of chronic inflammation in the bursal sac, as well as a lesser bone growth at the metatarsophalangeal joint. Also, the younger the patient the more able they are to move the affected joint normally, free of the ‘freezing’ that is often found in older patients. There is little conclusive evidence as to why this is so, but the consistent nature of these differences would indicate that the condition is not identical in juveniles and adults.

 

While it isn’t clear what exactly causes juvenile bunions to develop it is clear that all hallux valgus deformities are the result of inferior mechanical functioning in the metatarsophalangeal joint of the big toe, and any other issue found to cause pronation and instability in the first ray of the foot will only add to the problem. These other issues may include metatarsus adductus, congenital deformities, pes valgus (rocker bottom foot), obesity, immobile ankle joints, and/or muscular imbalances, all of which can cause uneven pressure points in the feet and toes.

 

Dealing with bunion development in juveniles may become as much of an emotional issue as it is a physical one as this particular age group is often extremely sensitive to perceived criticism or looking different from their peers. While they may not wish to appear different by having a ‘deformity’ such as hallux valgus, they may not wish to appear different by avoiding the type of footwear or activities that amplify the problem as well. Care should be taken to be sensitive over this issue, even if the deformity is minor.
More troubling for many adults is the possibility that a child’s level or choice of activity may be limited by this affliction. While it isn’t typical for this age group reduced activity levels and difficulty finding well-fitted, appropriate footwear may be an issue. Bunions development in juveniles should be examined by a podiatrist who specializes in children’s feet, particularly if there are issues concerning physical activity, shoe fittings, or the use of orthotic devices.