Bunions! Myths, Misconceptions & Movement with Dr Emily Splichal

EBFA Global

22 Dec 202085:25

EducationalLearning

32 Likes 10 Comments

TLDRIn this informative webinar, Dr. Spickle discusses the misconceptions surrounding bunions and their impact on movement. He clarifies that bunions are not a growth but a bone deviation, specifically at the first metatarsal head. He emphasizes the importance of understanding the underlying causes, such as ligament laxity and foot instability, and explores both non-surgical and surgical treatment options. Dr. Spickle also addresses the global impact of bunions on body mechanics and the role of corrective exercises and orthotics in managing the condition.

Takeaways

📚 Bunions are not a growth but a deviation of the first metatarsal head, which pushes out and causes the bump commonly associated with bunions.
👟 The belief that bunions are caused by shoes such as high heels or pointed toes shoes is a misconception; the underlying issue is often related to foot mechanics and stability.
🦶 Bunions can significantly impact movement patterns and overall body mechanics, potentially leading to issues such as hip, back, knee pain, and ankle sprains.
🧬 While there is a genetic predisposition towards bunions due to factors like ligament laxity, the actual formation of a bunion is not directly遗传.
🏃‍♀️ Corrective exercises can help manage and slow the progression of bunions, but they cannot reverse the structural changes associated with severe bunions.
🩺 The intermetatarsal angle is a key measurement for assessing the severity of bunions, with angles increasing from mild to severe.
🔪 Surgery may be recommended for bunions that are painful, have poor joint health, or are affecting the patient's quality of life, with the goal of stabilizing the metatarsal joint.
🩰 The use of orthotics, toe spacers like Correct Toes, and bunion booties can provide support and stability for those with bunions, especially during physical activities.
🤔 The efficacy of bunion surgery is high when performed correctly, addressing the root cause at the metatarsal joint, rather than just the cosmetic appearance.
🧐 It is important to differentiate between bunions and other foot conditions such as hallux rigidus or metatarsal adductus, as they require different treatment approaches.

Q & A

What is the primary misconception about bunions?
-The primary misconception is that bunions are a growth on the side of the foot. In reality, bunions are a deformity involving the first metatarsal bone pushing out and causing the big toe to angle towards the other toes.
What is the actual cause of bunions?
-Bunions are primarily caused by instability of the first ray, which is often due to rearfoot pronation, weak muscles such as the posterior tibialis, glutes, or core, ligament laxity, or limited ankle dorsiflexion.
How can the severity of a bunion be assessed?
-The severity of a bunion can be assessed by measuring the intermetatarsal angle on an x-ray. Normal is 8-10 degrees, mild is 10-12 degrees, moderate is 12-14 degrees, and severe is 14-16 degrees or more.
What are some of the local symptoms experienced by individuals with bunions?
-Local symptoms of bunions include a widening of the foot, difficulty fitting into shoes, bursitis (inflammation of the bursa causing a fluid-filled sac), neuromas, pain in the first metatarsophalangeal joint (MTPJ), arthritis, and potential dislocation of the second toe.
How do bunions affect overall movement patterns?
-Bunions can alter stride length, leading to less hip extension and inhibition of the glutes. This can result in low back pain, knee pain, ankle sprains, plantar fasciitis, and other issues related to altered movement patterns and compensations.
What are the recommended corrective exercises for bunions?
-Recommended corrective exercises for bunions include short foot exercises, posterior tibialis muscle exercises, and exercises that strengthen the intrinsic muscles of the foot. These exercises aim to improve foot stability and overall foot to core sequencing.
Can surgery correct bunions?
-Surgery can correct bunions by addressing the structural issues at the metatarsal-cuneiform joint. The success of surgery depends on the procedure performed and the expertise of the surgeon. It is important to choose a procedure that stabilizes the joint to prevent the bunion from returning.
What are some misconceptions about bunion surgery?
-Misconceptions about bunion surgery include the belief that the surgery is not effective, that bunions will always return after surgery, and that there is a high failure rate. These misconceptions often stem from inappropriate surgical procedures or poor术后 care.
What is the role of orthotics in managing bunions?
-Orthotics can provide support and stability to the foot, especially in individuals with ligament laxity or severe overpronation. They work in conjunction with corrective exercises to slow the progression of bunions and improve overall foot function.
How do bunions impact the pelvic floor and core stability?
-Bunions can delay foot stability, which in turn affects the timing and activation of the deep core and hip stabilizers. This can lead to compensatory movements and potential issues in the pelvic floor and core stability.
What are some non-surgical treatment options for bunions?
-Non-surgical treatment options for bunions include corrective exercises, orthotics, the use of devices like bunion booties or correct toes, and taping. These methods aim to improve foot function and slow the progression of the bunion, but they cannot reverse the structural changes caused by the bunion.

Outlines

00:00

🎤 Introduction and Welcome to the Webinar

The speaker welcomes the audience to the EBFA webinar, acknowledging both newcomers and long-time followers. The topic of discussion is bunions, their misconceptions, and their impact on movement. The speaker, Dr. Splickel, introduces himself as a functional podiatrist and founder of EBFA Global, and sets the stage for the webinar by debunking the myth that bunions are a growth on the side of the foot.

05:00

🦶 Anatomy and Biomechanics of Bunions

Dr. Splickel delves into the anatomy and biomechanics of bunions, clarifying that bunions are not overgrowths but rather the first metatarsal head pushing out of the foot. He uses an X-ray to illustrate the actual medial eminence and explains the importance of the first metatarsal bone in foot stability and movement. The speaker also discusses the evolution of the human foot and the significance of the first ray in foot anatomy and function.

10:03

📈 Bunions Measurement and Progression

The discussion moves to how bunions are measured, focusing on the intermetatarsal angle rather than the size of the bump. The speaker explains the impact of bunions on joint alignment and the risk of arthritis, highlighting the importance of joint space and the role of sesamoid bones in foot stability. The progression of bunions and their local symptoms, such as bursitis and neuromas, are also covered, emphasizing the need for proper footwear and treatment.

15:03

🌐 Global Impact of Bunions on Movement

Dr. Splickel expands on the global impact of bunions, explaining how they affect overall movement patterns and can lead to issues like hip and back pain, knee pain, and plantar fasciitis. The speaker discusses the relationship between bunions and rearfoot pronation, highlighting the role of muscle imbalances and ligament laxity in bunion formation. The speaker also addresses common misconceptions about the causes of bunions, including the role of shoes and genetics.

20:06

🏋️‍♀️ Corrective Exercises and Bunion Management

The speaker discusses the role of corrective exercises in managing bunions, emphasizing the importance of strengthening the posterior tibialis and core muscles. The intricacies of intrinsic muscle balance around the first metatarsal joint are explained, along with the ineffectiveness of certain exercises and splints in reversing severe bunions. The speaker also addresses the limitations of non-surgical bunion corrections and the potential need for surgery in severe cases.

25:09

❓ Addressing Misconceptions and Questions about Bunions

Dr. Splickel addresses various misconceptions about bunions, including the belief that exercises can correct severe bunions and the fear that bunion surgery is ineffective. He explains the importance of choosing the right surgical procedure and the potential for high success rates when done correctly. The speaker also discusses when he recommends surgery, considering factors like pain, joint health, and activity level. The webinar concludes with a Q&A session where the speaker answers questions from the audience, providing further insights into bunion management and prevention.

Mindmap

Keywords

💡Bunions

Bunions are a common foot deformity characterized by a prominent bump at the base of the big toe, often accompanied by the toe leaning towards the other toes. In the video, it is emphasized that bunions are not just a cosmetic issue but can significantly impact movement patterns and overall foot health. The speaker clarifies that bunions are not simply an overgrowth of bone but rather a misalignment of the first metatarsal head, which pushes out from the foot due to the deviation of the first ray.

💡Metatarsal

Metatarsals are the long bones in the foot that connect the toes to the ankle. The first metatarsal is particularly significant in the formation of bunions, as its deviation from its normal alignment leads to the characteristic bunion prominence. The speaker explains that bunions are more of a metatarsal issue than simply an angulation of the big toe.

💡First Ray Instability

The first ray instability refers to the instability at the first metatarsal joint (metatarsal-cuneiform joint), which is the central point of deformity in a bunion. This instability can cause the first metatarsal to deviate outward, leading to the formation of a bunion. The video emphasizes that addressing this instability is crucial for effective bunion treatment and prevention.

💡Surgery

Bunion surgery is a treatment option discussed in the video, which can correct the deformity by addressing the underlying instability at the first metatarsal joint. The speaker clarifies that while surgery is the only way to truly reverse a severe bunion, it should be considered based on the severity of the bunion, joint health, and the patient's activity level and age.

💡Correct Toes

Correct Toes is a product mentioned in the video that serves as a toe spacer designed to help align the big toe and potentially slow the progression of bunions. The speaker suggests using such devices in shoes to help maintain better toe alignment during movement, although it is noted that these do not reverse the bunion itself.

💡Intrinsic Muscles

Intrinsic muscles are the muscles within the foot that play a crucial role in stabilizing the foot and maintaining proper foot function. The video discusses how imbalances in these muscles, particularly those surrounding the first metatarsal joint, can contribute to bunion formation. Strengthening these muscles is part of the corrective exercise approach to managing bunions.

💡Orthotics

Orthotics are custom-made inserts for shoes designed to correct and support the arch of the foot and improve overall foot function. In the context of the video, orthotics may be recommended for individuals with bunions or those at risk of developing them, especially if they have ligament laxity or severe overpronation, to provide stability and potentially slow the progression of bunions.

💡Plantar Plate

The plantar plate is a thick band of fibrocartilage that supports the metatarsophalangeal joints of the toes. The speaker mentions that a tear in the plantar plate can lead to a dislocation of the second toe over the first, which is a complication that can arise in severe bunions. Maintaining the integrity of the plantar plate is essential for proper toe alignment and function.

💡Naboso Insoles

Naboso insoles are a type of footwear insert designed to stimulate nerve endings in the foot, thereby potentially strengthening the intrinsic muscles and improving overall foot function. The video suggests that while Naboso insoles may help with mild bunions by enhancing foot stability, their efficacy in more severe cases is limited and primarily palliative.

💡Rearfoot Pronation

Rearfoot pronation refers to the inward rolling of the foot from the ankle joint downwards, which can lead to instability in the foot and contribute to the formation of bunions. The video emphasizes that addressing rearfoot pronation through corrective exercises and potentially orthotics is an important aspect of bunion management and prevention.

💡Myth Debunking

Throughout the video, the speaker works to debunk several myths surrounding bunions, such as the belief that they are simply a growth on the side of the foot or that exercise can reverse severe bunions. The aim is to provide accurate information to help individuals understand the true nature of bunions and make informed decisions about their treatment options.

Highlights

Bunions are not simply a growth on the side of the foot, but rather a deviation of the first metatarsal head.

The actual medial eminence or 'bump' of a bunion is the first metatarsal head pushing out of the foot.

Bunions are often a result of instability at the first metatarsal joint (metatarsal cuneiform joint), not just excessive bone growth.

Bunion severity is measured by the intermetatarsal angle, not the size of the protrusion.

The first ray of the foot has its own axis, similar to the thumb of a primate, and plays a crucial role in foot stability.

Bunions can lead to a variety of foot issues including bursitis, neuromas, and problems with the second digit.

Bunion surgery involves correcting the instability at the metatarsal cuneiform joint, not just addressing the cosmetic appearance.

Exercise and corrective devices can improve alignment and potentially slow the progression of bunions, but they cannot reverse the structural changes.

The use of orthotics, corrective exercises, and bunion booties can help stabilize the foot and improve function for those with bunions.

Bunion surgery can have a high success rate when performed correctly, addressing the root cause at the metatarsal cuneiform joint.

Ligament laxity and hypermobility can predispose individuals to bunions, particularly in the case of juvenile hallux valgus.

Bunions can affect overall movement patterns, leading to issues such as hip pain, low back pain, and knee pain due to altered gait and posture.

The key to addressing bunions is understanding their underlying causes, which often involve instability and muscle imbalances.

Bunion correction often involves the release of the adductor hallucis muscle during surgery due to its strong deforming force.

The position of the sesamoids is a critical indicator of intrinsic muscle alignment and can be affected by bunions.

Bunions can be prevented or their progression slowed through early intervention, including foot strengthening and corrective exercises.

For severe bunions, surgery may be necessary to correct the structural issues and restore proper foot function.

Bunion surgery aims to realign the metatarsal cuneiform joint and can help prevent the return of the bunion when done correctly.

Bunions are not caused by shoes or genetics alone, but rather a combination of factors including foot structure and muscle function.

Transcripts

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