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Tag: foot

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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Athletes, Chiropractic Care, El Paso TX, Sporting , , , , , , , , , , , , , , , ,

Bunions Management: Relief and Care Strategies

What is the most effective method for managing the initial symptoms of bunions?

Bunions

A bunion, which is also known as hallux valgus, is a bony bump that is frequently excruciating and located on the side of the big toe. A misalignment of the big toe is the most prevalent cause of bunions. Redness, edema, tenderness, and thickened skin around the big toe joint are early indications of bunions. Although it is impossible to halt the progression of a bunion, it is possible to alleviate its symptoms as it progresses. Pain management strategies and various treatment options are among the early indications of bunions. (MedlinePlus, 2024)

Visual Signs of Early Symptoms

Bunions initially develop slowly and do not cause significant discomfort right away. When a bunion first begins to form, you can notice the following symptoms around your metatarsophalangeal (MTP) joint, which joins the base of your big toe to the remainder of your foot. (American Academy of Orthopaedic Surgeons, 2022)

  • Erythema
  • Edema Hyperpigmentation
  • Hyperkeratotic skin
  • A bony protrusion exists
  • Prominence where the hallux deviates towards the second digit or even beneath it
  • Calluses and corns

Initial Somatic Indicators

Although bunions may not be immediately apparent, they can still cause discomfort in the early stages. The following are some of the initial physical indicators of a developing bunion: (MedlinePlus, 2024)

  • Pain in the foot and big toe
  • This discomfort is especially evident during ambulation or when donning constrictive, pointed footwear.
  • Decreased movement of the big toe
  • Tenderness
  • Inflammation
  • Swelling
  • Stiffness
  • Heat

Stages

Bunions are typically progressive, meaning they tend to deteriorate over time. Failure to implement preventive measures for your bunions may result in consequences. Subsequent symptoms often accompany advanced-stage bunions. (American Academy of Orthopaedic Surgeons, 2022)

  • Persistent, intense pain in and around the metatarsophalangeal joint and the lateral and plantar aspects of the foot
  • Bursitis results in the formation of a fluid-filled cyst near the base of the big toe.
  • Hallux adducting and maybe overlapping the second toe
  • Excessive osseous proliferation along the lateral aspect of the hallux
  • Inability to accommodate your standard footwear
  • Impediment in ambulation
  • Hammertoe abnormalities occur when the second, third, or fourth toes exhibit an upward bend at the middle joint, like a hammer or claw.
  • Hallux rigidus, a kind of arthritis affecting the big toe

Halt the Advancement

Once bunions have begun to form, they will become irreversible. Nevertheless, some methods exist to prevent their exacerbation or the onset of additional issues. These encompass (American Academy of Orthopaedic Surgeons, 2022)

  • Refraining from wearing improperly fitting footwear and elevated heels
  • Utilizing orthopedic footwear and/or broad, comfy, soft-soled, and low-heeled shoes
  • Inserting spacers between the toes to avert friction and irritation
  • Applying over-the-counter (OTC) pads composed of felt, silicone, or foam to the bunion
  • Extending your calf muscles to enhance joint alignment

Analgesic Administration

Ice packs and non-steroidal anti-inflammatory medicines (NSAIDs), such as Advil or Motrin (ibuprofen), may alleviate bunion discomfort. Research indicates that Botox injections into the forefoot muscles may offer analgesic benefits. (Hurn, S. E., et al., 2022)

Non-invasive Therapy in Initial Phases

If your bunions continue to deteriorate despite using the aforementioned self-care measures, you may need to seek intervention from a podiatrist or another healthcare professional. A healthcare professional may advise

Foot orthoses, commonly referred to as orthotics

  • Orthoses, also known as foot orthoses, are specially designed implants that alleviate bunion-associated pain and prevent chafing.

Splints

Physical Therapy

  • A physical therapist can assist you by offering exercises to enhance the alignment of your feet and joints. They may further administer manual treatment to alleviate pain. (Hurn, S. E., et al., 2022)

Podiatrist

A podiatrist is a medical doctor (M.D.) specializing in the treatment of health issues affecting the foot, ankles, and lower legs. Request a referral to a podiatrist from your healthcare physician if you seek assistance in managing your bunion problems. (American Podiatric Medical Association, 2025)

Chiropractic Perspective

Chiropractors focus on biomechanical alignment and musculoskeletal health, viewing bunions as part of a broader kinetic chain dysfunction. Their approach emphasizes manual therapies and functional restoration.

  1. Biomechanical Assessment:
    • Evaluate foot, ankle, knee, hip, and spinal alignment to identify compensatory patterns contributing to bunion formation (e.g., overpronation, pelvic misalignment).
    • Assess gait and foot mechanics to identify areas of abnormal stress on the big toe joint.
  2. Chiropractic Interventions:
    • Adjustments: Perform gentle manipulations to the foot and ankle (e.g., metatarsal or tarsal adjustments) to improve joint mobility and reduce stress on the bunion. Spinal or pelvic adjustments may address upstream biomechanical issues.
    • Soft Tissue Therapy: Utilize techniques such as myofascial release or instrument-assisted soft tissue mobilization to reduce tension in the foot’s muscles and fascia, thereby improving circulation and flexibility.
    • Taping: Apply kinesiology tape to support the big toe and reduce strain during movement.
  3. Corrective Exercises:
    • Prescribe exercises to strengthen intrinsic foot muscles and improve toe alignment, such as:
      • Toe spreading: Actively spread toes apart to strengthen the abductor hallucis.
      • Arch strengthening: Perform short foot exercises to support the medial longitudinal arch.
      • Calf stretches: Address tight Achilles tendons that contribute to foot strain.
    • Recommend balance and proprioception exercises (e.g., standing on one leg) to improve overall foot stability.
  4. Orthotic and Footwear Guidance:
    • Fit patients with custom orthotics to correct overpronation or supination, which can exacerbate bunions.
    • Advise on minimalist or wide-toe-box shoes to promote natural foot mechanics, aligning with chiropractic principles of functional movement.
  5. Holistic Approach:
    • Address lifestyle factors, such as posture and ergonomics, that affect lower extremity alignment.
    • Educate on anti-inflammatory diets (e.g., rich in omega-3 fatty acids, low in processed sugars) to help reduce joint inflammation.

Nurse Practitioner Perspective

NPs focus on holistic patient care, symptom management, and coordinating multidisciplinary treatment. Their approach to bunions focuses on pain relief, slowing the progression, and providing patient education.

  1. Assessment and Diagnosis:
    • Conduct a thorough history and physical exam to evaluate bunion severity, pain level, and contributing factors (e.g., footwear, family history, arthritis).
    • Order imaging (X-rays) if needed to assess joint alignment and rule out complications like osteoarthritis or bone spurs.
    • Screen for systemic conditions (e.g., rheumatoid arthritis, gout) that may worsen bunions.
  2. Conservative Management:
    • Footwear Education: Recommend wide-toe-box shoes with low heels to reduce pressure on the bunion. Avoid high heels and narrow shoes.
    • Orthotics: Prescribe custom or over-the-counter orthotic inserts to support the arch, redistribute pressure, and correct foot mechanics.
    • Padding and Splinting: Suggest bunion pads or spacers to cushion the area and reduce friction. Night splints may help align the toe, though evidence for their effectiveness is mixed.
    • Pain Relief: Advise over-the-counter NSAIDs (e.g., ibuprofen) for pain and inflammation, ensuring proper dosing and monitoring for side effects. For severe cases, refer to a specialist for corticosteroid injections.
    • Physical Therapy: Refer to a physical therapist for exercises to strengthen foot muscles, improve flexibility, and enhance gait. Examples include toe stretches, towel curls, and marble pickups.
  3. Patient Education:
    • Educate on weight management to reduce stress on the feet.
    • Discuss lifestyle changes, such as avoiding prolonged standing or high-impact activities that worsen symptoms.
    • Highlight the progressive nature of bunions and the importance of early intervention.
  4. Referral and Coordination:
    • Refer to a podiatrist or orthopedic surgeon if conservative measures fail or if the bunion causes significant pain, deformity, or functional impairment.
    • Collaborate with chiropractors, physical therapists, or other specialists for a comprehensive care plan.

Both NPs and chiropractors emphasize:

  • Early Intervention: Addressing bunions early can prevent the worsening of deformity.
  • Footwear Modification: Wearing wide, supportive shoes is critical to reducing pressure.
  • Exercise and Mobility: Strengthening and stretching exercises improve foot function.
  • Pain Management: Non-invasive methods, such as padding, icing, or non-steroidal anti-inflammatory drugs (NSAIDs), are the first-line approach.
  • Referral for Surgery: If conservative measures prove ineffective, a specialist may be consulted for surgical options, such as bunionectomy, although this is typically considered a last resort.

Limitations and Considerations

  • Evidence Gaps: While orthotics and exercises are widely recommended, studies on their efficacy for bunions are limited. Splints may not correct severe deformities.
  • Individual Variation: Treatment must be tailored to the patient’s bunion severity, lifestyle, and comorbidities.
  • Surgical Indications: Severe pain, joint damage, or inability to walk may necessitate surgical consultation, which neither NPs nor chiropractors are qualified to perform.

Injury Medical Chiropractic and Functional Medicine Clinic

Dr. Jimenez, a nurse practitioner, integrates medical expertise with chiropractic care to address a wide range of conditions. The clinic provides individualized care programs that incorporate functional medicine, acupuncture, electroacupuncture, and sports medicine. The clinic addresses chronic pain syndromes and injuries by prioritizing strength, agility, and flexibility. Comprehensive care programs, combined with in-person and virtual health coaching, ensure personalized treatment and wellness outcomes for patients of all ages and abilities.

Enhance Your Performance with Functional Foot Orthotics

References

MedlinePlus (2024). Bunions. U.S. Department of Health and Human Services.

American Academy of Orthopaedic Surgeons. (2022). “Bunions.” OrthoInfo. from https://orthoinfo.aaos.org/en/diseases–conditions/bunions/.

Hurn, S. E., Matthews, B. G., Munteanu, S. E., & Menz, H. B. (2022). Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta-Analysis. Arthritis care & research, 74(10), 1676–1688. https://doi.org/10.1002/acr.24603

Aebischer, A. S., & Duff, S. (2020). Bunions: A review of management. Australian Journal of General Practice, 49(11), 720–723. https://doi.org/10.31128/AJGP-07-20-5541

American Podiatric Medical Association. (2025). “What is a podiatrist?” Advancing foot and ankle medicine and surgery. from https://www.apma.org/patients-and-the-public/what-is-a-podiatrist/.

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Physio, Therapy , , , , , , , , , , , , , , , , , , ,

Pigeon Toed: Causes and Treatment Options

Children walking with their toes pointed in may be pigeon-toed. What are the causes, conditions associated with it, and treatments?

Pigeon-toed Walking

If a child walks with their feet turned inward at the toes, it is usually described as being pigeon-toed. This pointing inward of the feet occasionally occurs as a child learns to walk and may continue through toddlerhood. It is noticed more often in children than adults, but older individuals can experience it. Pigeon-toed walking is rarely a major orthopedic problem and usually disappears without treatment. However, there are times when it may impact a child’s lower extremities and hips. Bracing or surgery may be necessary in these cases to correct the problem. (Paramanandam V. et al., 2019) This condition is common and typically is caused by abnormal birth positions in utero. Sometimes, slight issues may lead to noticeable functional characteristics. Mild changes in bone shape and positioning usually cause pigeon toes. Often, it subsides in a few years as the child continues to develop.

What Does It Mean?

There is usually no need to worry, as this condition is likely not permanent and will go away in a few years. (Paramanandam V. et al., 2019) However, it is recommended that you check in with your healthcare provider to ensure the child is developing normally. Some adults walk with their toes turned in. This may be due to a birth defect, a weakness, or a rare case of pigeon-toed walking as a youth that was left untreated or did not go away.

Causes

There are various reasons for pigeon-toed walking. To determine the cause, a healthcare provider can assess the child’s condition and make a diagnosis, including:

Metatarsus Adductus

  • A condition where the front part of the foot is turned inward.
  • The metatarsals are the long bones of the forefoot.
  • This is when the bones of the foot point inward, leading to pigeon-toed walking.
  • A clinical examination and X-ray can confirm the metatarsus adducts as a cause of pigeon-toed walking.

Tibial Torsion

  • A twisted shinbone (tibia) can cause the feet to turn inward in younger children.
  • The shinbone/tibia in some children may be slightly twisted.
  • The tibia can either turn outward or inward.
  • When it twists inward, it may manifest as a pigeon-toed gait.
  • Tibial torsion may accompany femoral anteversion.
  • It is diagnosed with an X-ray.
  • Children with tibial torsion typically grow out of the problem, and the pigeon-toed disappears by age 4. (Uden H., & Kumar S. 2012)

Femoral Anteversion

  • A common cause, especially in older children, is when the thighbone/femur is twisted inward.
  • If the femur turns inward and forward unnaturally, where the femoral neck meets the body of the femur, it is called femoral anteversion.
  • An outward and backward rotation of the femur is called femoral retroversion.
  • This occurs in about 10% of children. (Scorcelletti M. et al., 2020)
  • Many children with femoral anteversion appear knock-kneed with a large gap between their feet when standing with knees together, and when they walk, they appear pigeon-toed.
  • A clinical examination and X-ray diagnose it.

Symptoms

In most cases, the child does not complain of any pain. However, if pain is felt, it can include:

  • Tightness in the calf muscles
  • Aching on the outer edges of the feet
  • Knee pain

Usually, parents will notice pigeon-toes when their child is first learning to walk. Rest assured, the child most likely is not experiencing pain. They have feet and knees that turn inward when they walk and run. (Uden H., & Kumar S., 2012)

A pediatrician or primary care provider can assess the situation and make recommendations. Most pigeon-toed children begin walking and running normally after age 3 or 4, so a watch-and-wait approach is used. Parents may have to take their child to a specialist, like an orthopedic surgeon, if they complain of pain while walking. A specialist may be referred if the child cannot walk due to the inward turn of their feet.

Risk Factors

Pigeon-toed walking is not a preventable condition but rather one that develops during pregnancy. Causes may include: (Scorcelletti M. et al., 2020)

  • A pregnancy with twins or multiple births
  • Large fetus
  • Breech position in utero when the baby is positioned feet first.
  • Not enough amniotic fluid

Muscle Weakness in Adults

Adolescents or adults who notice their knees turn in and walk pigeon-toed may have weakness in the hip and leg muscles that control the position of their legs when they walk. Strengthening those muscles can help. (Scorcelletti M. et al., 2020)

Treatment

Typically, a normal gait will appear by the age of 3 or 4. Other treatments may include:

Physical Therapy Exercises and Gait Training

  • Exercises to stretch tight lower extremity muscles and strengthen hip and leg muscles can help improve walking gait.
  • See a pediatric specialist before starting, as research shows that parental stretching of a newborn with metatarsus adductus offers little benefit. (Eamsobhana P. et al., 2017)

Bracing or Casting 

  • Braces
  • Serial casting is a procedure that helps children improve their range of movement and may be done to place their lower extremities in an optimum position as they develop. (Uden H., & Kumar S., 2012)

Surgery

  • For cases in which tibial torsion is the cause, osteotomy surgery, which involves cutting and/or removing bone, may be recommended to correct the structural deformity of the shinbone.

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Foot Pronation

References

Paramanandam, V., Lizarraga, K. J., Soh, D., Algarni, M., Rohani, M., & Fasano, A. (2019). Unusual gait disorders: a phenomenological approach and classification. Expert review of neurotherapeutics, 19(2), 119–132. https://doi.org/10.1080/14737175.2019.1562337

Uden, H., & Kumar, S. (2012). Non-surgical management of a pediatric “intoed” gait pattern – a systematic review of the current best evidence. Journal of Multidisciplinary Healthcare, 5, 27–35. https://doi.org/10.2147/JMDH.S28669

Scorcelletti, M., Reeves, N. D., Rittweger, J., & Ireland, A. (2020). Femoral anteversion: significance and measurement. Journal of Anatomy, 237(5), 811–826. https://doi.org/10.1111/joa.13249

Eamsobhana, P., Rojjananukulpong, K., Ariyawatkul, T., Chotigavanichaya, C., & Kaewpornsawan, K. (2017). Does the parental stretching programs improve metatarsus adductus in newborns?. Journal of Orthopaedic Surgery (Hong Kong), 25(1), 2309499017690320. https://doi.org/10.1177/2309499017690320

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Therapy , , , , , , , , , , , , , , , , , , ,

Hamstring Syndrome Relief for Sciatic Nerve Pain

Individuals dealing with pain in the buttocks and in the back of the thigh, along with numbness and tingling down to the bottom of the foot, may be experiencing hamstring syndrome, a condition caused by pressure on the sciatic nerve. What is the recommended treatment?

Hamstring-Syndrome Relief

The hamstrings are three muscles in the back of the thigh, extending from the pelvis or upper thigh across the back of the knee to the leg. This muscle group is important for bending the knee, straightening the hip, and stabilizing the knee. The sciatic nerve is a large nerve that runs from the lower back down the legs. It usually passes near or through these muscles, and the pelvis then runs under these muscles in the thigh. Hamstring syndrome refers to pain in the buttock and back of the thigh, often radiating down the leg, caused by compression or irritation of the sciatic nerve at the hamstring-insertion point on the ischial tuberosity, typically due to tight or scarred tissue. (Sakari Orava, 1997)

Pain Location

The pain is primarily felt in the buttock and back of the thigh, sometimes extending down the leg. It’s characterized by pressure on the sciatic nerve, which runs through the buttock and into the back of the thigh, where it supplies the hamstring muscles. (Kaiser Permanente, 2024)

Mechanism

This pressure can occur due to: (Sakari Orava, 1997) (Kaiser Permanente, 2024)

Fibrotic Bands

  • Tight, tendon-like, or scarred bands of tissue at the hamstring’s insertion point/ischial tuberosity can irritate the sciatic nerve.

Compression

  • These bands can compress the nerve, especially when sitting or during activities that involve hip flexion and knee extension.

Traction

  • The sciatic nerve can also be stretched or irritated by the hamstring tendons.

Symptoms

  • Pain in the buttock and back of the thigh may radiate down the leg.
  • Pain that is worse when sitting, stretching the hamstrings, or during activities like running. (Puranen J. & Orava S. 1988)
  • Numbness or tingling in the back of the leg

Differential Diagnosis

It’s important to differentiate hamstring syndrome from other conditions that could be causing similar symptoms, including:

  • Piriformis syndrome
  • Ischiogluteal bursitis
  • Hamstring muscle strains

Treatment

Hamstring syndrome relief may consist of the following:

Conservative

  • Initial treatment focuses on rest, ice, stretching, and over-the-counter pain relievers.

Physical Therapy

Injections

  • In some cases, injections with cortisone and numbing medicine may be used to reduce nerve inflammation and pain. (Lower Limb Surgery, 2024)

Surgery

  • In severe cases, surgery may be necessary to release the compressing bands and free the sciatic nerve. (Lower Limb Surgery, 2024)

Injury Medical Chiropractic & Functional Medicine Clinic

Talk to a healthcare provider about what interventions would help the most. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Sciatica: Causes, Symptoms and Tips

References

Orava, Sakari. (1997). Hamstring syndrome. Operative Techniques in Sports Medicine, 5(3). https://doi.org/https://doi.org/10.1016/S1060-1872(97)80035-4.

Kaiser Permanente. (2024). Hamstring Syndrome: Care Instructions. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.hamstring-syndrome-care-instructions.abr3618

Puranen, J., & Orava, S. (1988). The hamstring syndrome. A new diagnosis of gluteal sciatic pain. The American Journal of Sports Medicine, 16(5), 517–521. https://doi.org/10.1177/036354658801600515

Zion Physical Therapy. (2023). Hamstring Tendinitis Vs. Hamstring Syndrome. https://www.zionpt.com/post/hamstring-tendinitis-vs-hamstring-syndrome

Lower Limb Surgery. (2024). Hamstring Syndrome. https://www.lowerlimbsurgery.com/hamstring syndrome#:~:text=General%20Treatment%20Considerations,%E2%80%8B