Bunions and Hammer Toes

Hi, we're gonna talk about the big toe, bunions, and balance, and the ways that you can help people with issues with the great toe, and how it limits their performance in Pilates. And some, I'm gonna share some tools and some products that actually help with correcting the big toe alignment and actually improving mobility in the great toe. I've Candice here. Thanks for coming. Thank you.

She's gonna share her pathologies in her feet with us and give us an opportunity to see someone with both great toe limited flexion and extension. Slightly limited. She's not hugely limited there. She's gonna also show a little bit of the bunion and how that foot is affected by the bunion, and we're gonna actually see some hammer toe corrections, as well. So, she's brought all of those to us to share.

First, what I want to do is look at her foot in a neutral, sort of relaxed position. So I like this position just sitting with the knees bent to about a 90 degree angle, the feet just relaxed on the surface, and just look at how the arch is. How her feet are naturally positioned when they're relaxed. So you can see that she does have a nice arch. She has a bunion on both sides and the left one is a little greater than the right.

She also has some hammer toes that you can see there. And what's I'm gonna do first, is see how mobile all of these are. So, first, I'm gonna take the finger and put it against the metatarsal head on one side, and the other, and just seeing how mobile that is. And what I'm noticing is that the left side is a little less mobile than the right and the toe is also externally rotated a little bit. So, we're gonna work on that.

And then I'm gonna go back and look at the hammer toes and see how much I can extend that second digit there. And then the same thing here. So there's a good bit of stiffness there that I'm gonna be working on. And the amount of joint stiffness is going to predict how well they're gonna do. If I could straighten it all the way out, then I would have a good prognosis for correcting it completely.

But if I can't straighten it all the way out it's probably been there for many years and we're just gonna try to keep it from getting worse, so. Okay, so that being said, I'm gonna show you some products that I brought to share that are helpful for people with bunions. I'm not advocating any of these products, specifically. I just wanna share some of the products that are online. You can just go onto Amazon and Google them and find them online very easily.

And they're all under $10, which is really nice. So don't spend a lot of money for these products. Alright, so the first one is the little sock that goes around the big toe. And then this keeps a pad in place. And so we're gonna put that on her toe.

Let's do this side, and put it around the toe so it just creates a little sock that goes around the big toe, and the elastic fabric will actually help to, help to pull the toe in position. This fabric is very soft, so I'd actually like more elasticity on the outside here to correct it. But this gives her a nice little pad here that is very helpful. Now, I'll show you on the skeleton what we're doing. So if we make her foot look like.

Make the skeleton's foot look like this one, so you'll see that at the metatarsal phalangeal joint, also called the MTP, thank goodness we have a short term for that. You can see that the bunion sticks out. There is a growth that happens with bunions, so you'll see that protruded bone, it's not just the bone sticking out but it's actually a growth that does happen. And we think that might be from friction against the shoes and things like that. So, what we'll do is try to correct that joint.

Bring it over into better alignment. Take some of the stress off of it, if it's painful. So some of these products are really helpful if people have pain. Alright, so let's try a different one now. I'm gonna take that one off.

Does that bone growth, or does that growth go away if you do align your feet correctly? It gets better, but as soon as I put this into position I look at what I have left. That you're not gonna get rid of. I see. Right, that's gonna stay.

But, what we hope is that it doesn't get worse. I might not be able to improve it, unless you're really diligent about stretching. Just like you're trying to stretch your hamstrings. It takes time and you have to do it every day. So, if you do work every day, you can get this better.

As we've been playing with her foot, this morning, getting ready for the presentation, she's actually getting more and more mobile. So, it's nice to see. So I think that's a good prognosis. Alright, so now, we're gonna put this in between. So this has a spacer with it, which I like.

And the pad. So this has a nice gel pad that gives her some cushion if she's painful, and also gives her a little space. So you can see that there. And, you can see the shape of it here. And it's a really soft cushion.

And then these are just little gel devices that go in between the toes, and they require shoes. So, they kind of fall out if you just wear them around the house, Or if you're wearing them with bare feet you would need to wear shoes with these to keep them in. So, that's a good one for using for shoes. And then this is one of my favorites. It's super soft and comfortable, and it goes around the big toe, and all the other toes.

So, I think this one is the most effective ones to wear often, or all day long, because it's so soft and comfortable. Alright, I put this in here and I'll show you what it looks like. I'm gonna get it set. So what I love about it, too, is that you put your fingers in between each toe, and that in itself is therapeutic for stretching your foot. And, getting it around that pinky toe's challenging sometimes.

And then you push the little dividers in between the toes and then once you get it in there, you kind of pull on your toes and stretch them out and get it to wear it doesn't have any wrinkles in it and it's placed properly. And then you can see how that. And then just keep your foot very relaxed. There's some tension in her foot here that we wanna work on as well. You can see that tendon on that second toe getting a little bit tense.

And then you see that that creates that space there. And normally this is soft enough to wear, people can wear it for several hours. And you would build up the time. You don't just start out with all day long. The first day you'll be really sore.

So, you want to do it for just a little while, maybe an hour or so, and then work up to two hours, and then just increase your time in it. And then I would love for you to wear it when you're doing your Pilates workout, too. Okay? So that's that particular one, and it's just called a gel toe separator. And this one Candice actually brought.

It's a little stiffer, so it's gonna be very effective for spreading the toes apart. But it's also quite, it's rigid, so she might not be able to tolerate that for long periods of time. What's been your experience with this one? Maybe three hours at the most. Yeah, right, right.

Because it's pretty stiff, so let's stick it in there and see what it looks like. It's harder to get on because it's a little stiffer. And then, so you'll see that it doesn't have the wraps around. And much stiffer than the other one, so that's why it's not gonna be as comfortable as the other gel. Okay, yeah.

So you have to work on the toes, getting them into a good position, and again, just donning these devices is very therapeutic. You're paying attention to your toes. So, again, that's very stiff. It's going to spread your toes apart, it's very effective, but then you won't be able to wear it as long. But, it will be good to wear during a Pilates class as well.

Alright. It's not as flexible as that one. Right. Because I can feel it all in the back of my toes but I like the way that this toe is very nice and straight. Good, yeah.

So that might be something that she would wear for a few hours a day, and then wear the other one more often, maybe to sleep in even. The other one to sleep in. Okay, then there's the big daddy yoga toe one. And, this one is the largest one. Very effective, but then, of course, you can't wear this one with shoes.

And you also can't wear this one all day long, because she would be in agony, probably. So I'm really shoving it in there. It's a little bit too big, I think, maybe. But, tell me your experience with this. Because she has a really interesting experience that she had the first time she used it.

Well, I did a reformer workout with these on and felt like it really opened my hips, my back, my hamstrings, everything. It was incredible. Yeah. It really was. Yeah.

That's great. And the stomach massage. I could just feel everything open up. Right, and so that's how when the feet are squeezed together, that's our foundation. So, when we're able to really connect with the surface, spread those toes apart, it gives the nerves more space, reduces Morton's neuroma.

Those are very common with people that have the pain between the metatarsals. These are great for that. And again, she could wear that for about an hour during the class, or maybe a couple hours a day and that could be very useful for a deeper stretch. It's like if you were gonna lay down and stretch your hamstrings, you wouldn't do it for three hours, right? You'd just do it for a short time.

Okay. So that's that one. And, then, what we're gonna do, is look at some exercises using the toe corrector, and also replacements for the toe corrector. So I'm gonna have you put both feet up there and then we'll take Mr. Skeleton away. Alright.

So this one is a larger spring for the toe corrector, and this one's the smaller spring. So, more sensitive feet, more painful feet would wear this kind, and we'll start with her on the softer one. Separate your feet quite a bit. And then, I like to call this more of a toe stretcher because you can't really do exercises with it. You'll notice that these abductor muscles are very weak.

So, and they don't generate a lot of force, and it's almost impossible to use any resistance with them. But what we're gonna do is just have her spread the feet apart, like a fan. And then turn. Yep. And so what you'll see is that stretches the toes.

So, I like to put it really close on that proximal phalanges and that way she really gets that metatarsal phalangeal mobilization. And then go ahead and keep pulling apart and then return. And then pull. And return. You try to drag your feet across.

And we're gonna try to keep her feet as relaxed as possible so she doesn't grip the floor with the hammer toes. And then she could also do at the distal part. And let's see what that looks likes. She puts it on the distal phalanges. Good.

Around the distal phalanges that's a little better. I like that better. That actually looks good. It straightens that rotation out a little bit. So I would suggest that she do it in this position.

That's gonna be better correction. Nice. And how does that feel as far as the strength of the spring. Feels good. Feels good, okay.

So she could progress to doing the larger spring, as well. Do you do it around every toe, or just the big toe? Just the big toe. The great toe. I like calling it the great toe.

The great toe, yes! Exactly. Then she could do some exercises where she is lifting the toe while she's got this on, which I love. That's really great. That works well. So that she's strengthening that flexion extension in that abducted position.

Okay. And then even better would be if you could send your heels forward and then just let your feet be in a dorsal flex position. So, yeah, just like that. And just let your feet be kind of relaxed. That's it.

And then flex. Pull apart first. Get the correction. And now try to flex the toes. That's gonna be a little harder.

Good. So that's gonna be a little more challenge. So she flexes the toes there. And then sometimes it's easier if she's on a surface. So if I put her at the end of the box here.

Now wrap your toes around. Yeah. Oh but I don't have enough tension. Yeah, so keep the tension, and wrap the toes around. Nice.

Yeah, that looks good. And of course, if you don't have a toe corrector, you could use something like a little loop. So we'll switch to this. These are just these little loops that have some elastic quality. Like a little theraband.

And then separate your feet a little bit more. There you go. And then you do the same thing. So, wrapping around. That looks already better.

That's really good. Nice. Excellent. Now, you can also use a ball. I have all different sizes and shapes of balls.

So, a tennis ball could be good. Put that under there. Let's see what that looks like. And you want to put it under the joint that you want to affect. So if you want to affect the great toe, I'm gonna put it under the great toe.

And then, if I want to get more under the second, then I'm gonna put it over here, and my goal is to try to see that metatarsal head stick up a little bit. There it is. That's perfect. And then, let's look at the next one. And see that?

That looks really good, too. So, if I'm getting that, then I know I'm getting some flexion at that joint. And then let's go out to the outside. So I can target where I wanna work. That looks really good.

Okay, then if that ball. We can kind of see what this smaller one does, if it's better or worse. Yep, I like that, too. That looks pretty good, yeah. And so you can try different sizes of balls and surfaces.

Especially if you're not using the reformer to wrap around. Great. And then if you want to do a makeshift reformer, you could take a brain stick and then, let's put it at the very end so you can wrap your toes around. And then wrap it around the brain stick. Now, I actually like the tennis ball the best.

I think that does, is the most effective. And we want to get over on this foot. Now put the ball of your foot on the top of that bar. There ya go. So it's kind of like your toes are hanging over the ledge.

Yeah, there you go. That looks good. So that's gonna actually help her hammer toes quite a bit. We're gonna do other things to help them, as well, but what we need is flexion at this joint and extension at the next joint. So the DIP and the PIP.

That's it, good. Nice. Okay, now. Now that we've played with all the toys, and for $9.99 on QVC you can get another set of foot correctors. If you buy within five minutes.

Alright, so, alright. Now, I'm gonna show you one more thing before we stand up. Now, I've taken a theraband and I just cut a little piece of it off. And, again I was saying that this muscle, the adductor muscle here, the adductor muscle is very weak, usually. So, if I give her some resistance, then I ask her to pull the toe across.

She, that looks pretty good, yeah. So, some people can't even move it at all, so giving that little bit of resistance to try to strengthen the muscle that's gonna correct that posture. That looks pretty good. So it's this muscle that you're trying to strengthen right here to get the Right. Toe to go out.

Exactly. I can feel it kind of work, barely working yeah. That looks excellent, so the more focus she has on her feet, the better she's doing because she could not actually do this about 15 minutes ago so that looks great. And is that, is that the range than it would move or would somebody? Yeah so I mean ideally.

For me or? You would have to move all the way to here, right, but that's very stiff and she's gonna really fight that stiffness in order to fix the foot so yeah that's good. Alright, now and so this is really thin and you know medium attention theraband and you can also use a broccoli, rubber band but sometimes that's even too hard so we can do it on this side, let's see how she does on this side. And then take it across. Yeah so that one's even harder, she's a lot stiffer on this side so she's gonna fight that stiffness quite a bit.

So I might just have her do it without anything and and just, make sure that the foot is not actually in weight bearing 'cause that friction in the surface is gonna prevent her from doing that abduction. I have to use my teeth to. Yeah (laughing) you have to hold your jaw just right to do it, yeah exactly. Aha. I can't do it.

That's okay just getting the idea of doing it and also getting this muscle in here that adductor muscle, adductor hallucis that comes across here underneath, you can massage in between the metatarsals and you can use that little ball, this little tiny marble, it's like a ball that you play jacks with. That, and you can press in like that and do a little massage in between there. And that's an easy way to get under the foot, you don't actually have to bend forward and get under it. But you can just cross the legs, just play with your feet. So I just suggest that people, you know, while they're watching television, they can go into that, just cross legged position, leave that there.

Oh okay. Right and then cross this leg. Cross this way? And then at the shin, and then just get in here and start playing so I want you to put your thumb here. Here?

Mhmm, and the index finger here. And then pull the foot so that the toe's in line, pull the toe so it's in line with your foot and then lift up here, so you're gonna. I'm sorry I'm not watched that. Okay so put your thumb here. Aha and then put the index finger here.

Aha. That's it, pull the foot, toe down a little bit and then pull. So watch what she does there. Yes so it's the same thing I was doing, bringing the foot into more abduction. Looks good.

Yeah, nice. So she can do that periodically throughout the day This is a project isn't it? It is, but you know if you wanna correct it it takes a lot of attention and focus. You can't just do it every once in a while, you won't get any results. Yeah.

And then as she wears something like this, the soft spreader, toe spreader throughout the day, combined with that once a day. I mean, really five minutes. Five minutes, spend five minutes working on your toes and then wear this more often or the larger one that you like during your reformer classes and then you're set, you know, it's probably not gonna get any worse, yep. Certainly should help with the pain and help with the motion as well. Okay now let's come up to standing, I'm gonna move the box away.

And let's just see how you normally like to stand. So looks like she's, usually when she's not thinking about it, she's turned out so that's an indication of how her hips are functioning and then we see what the state of her feet are in this position, so we see that there are the bunions, there the little hammer toes. Her arches look really good though I'm happy with the arches, she's not a pronator and if she were a pronator, what I would see is the collapsing of the arch downward, and I would also see that the subtalar joint would not be in a neutral position, so in order to find that subtalar neutral position, you're gonna grab underneath the malleus just behind the anterius tibialis tendon so lift your toes up and you'll feel, you'll see those, that group of tendons pop up and then the toe extensors and the anterior tibialis and you go right behind it and that's the talus so you wanna see if that talus is balanced by seeing if you're feeling more of it on the index finger or more of it under your thumb, you should feel it equally under both. And so if you're rolling in and out, I would have her roll in, roll out, she's actually in a good neutral position to start with, so I don't need to have her do anything different than she already does. I would like to work a little bit on the hips here and see if we can get her standing with her feet together more often, that will give her that sense of alignment and probably stretch the hips a little bit, so bring your feet all the way together.

I tease my clients and say, you know, put your bunions together right, 'cause the big toes don't actually go together and then we're gonna put, I wanna put these little toe separators in here for just right now, they're really simple to stick in there. Yep, that's good, okay and then let those toes stretch and relax. Excellent, alright now from here, we're gonna have her feel the gluteus medius so I'm gonna put my hands on your gluteus medius and have you side bend, not side bend but sway side to side just a little bit and when you sway to the right, which muscle do you feel, the right one or the left one? Under my fingers. Well.

That's okay, that's too much, you can't sway very much with your feet together. I don't. Okay put your hands here, let's help her identify that. Okay. Gluteus medius is gonna be really important for balance okay.

So now sway which muscle do you feel? I feel that one. Good, she sways to the left, she feels the left one, she sways to the right she feels the right one. Yeah. Okay so that's normal and what she should feel.

So now I want you to separate your feet and go out to your preferred position with the extra rotation a little bit. Now feel how they're off. They're off. You don't feel anything? They're off.

Alright, so in her natural position, they turn off which is part of the pattern that she's in. So then let's go back to parallel, turn your, and then keep your feet apart though and now they come on a little bit, feel that? Mhmm. So what I usually suggest to people who have any pathologies in the hips, knees or feet, ankles, feet, is to stand more often with your feet together and yep and then those muscles will be on more often, especially after a hip replacement or after any surgery when the muscles are kind of shut down, it's really great to have those muscles wake up again and standing with your feet together more often is really helpful. Alright our next exercise is to go up onto the tippy toes with heels together.

And watching for balance and thinking of a magnet between your heels going up and down. Now some people can't get their heels together because they have valgus and so I would just take a tennis ball or a pinky ball and put it in between the heels for some feedback and I want those heels to be able to touch or an object. So I've even used an eight inch ball for people with severe valgus. So they've gotta have something in between for feedback, okay. That looks good, excellent.

Okay one more time. Aha, now we're gonna watch to see how she grips the floor a little bit and the next thing we do is gonna be helpful. (laughing) okay I might give her a dowel or something to balance. Alright now, let me take these out for a second. And then what I want you to do is stand on one leg.

And lift the knee high in front of you. And so her balance is great, so that's excellent sometimes people can't even begin to balance there I want her to be able to balance for a minute or so on one leg, now can you do a heel raise? Are you rising up on your toe? And down. Whoa.

And then this is where the dowel comes in nice and handy. Oh man. You can hold here, and I don't want you to push on it, right, you're just holding with a finger lightly and I'm testing her calf strength. Now do you see how she's gripping the floor when she goes up on one toe? It means she's using those toe flexors to help her lift and that is an issue so what I would want is her to have the toes not in any weight bearing at all so I might put her on a little box with the toes kind of dangling over the edge and Marika Molnar did a wonderful tutorial on using her mini-parasetters where the toes are not in weight bearing and I think that's a great suggestion for you, so those would be great for you to use and so I want you to keep your toes lifted off the floor, now go up on your tippy toe.

That's good, yeah, toes look much better like that. And then I also wanna use the toe separator and then don't let this foot touch the other one. There you go, cheating, there you go, good. Okay and again, having those toes lifted a little bit is gonna be helpful for her, good. Alright, now the next frontier is looking at great toe extension, so have a seat here for just a moment let's look at that.

Just sit right here, yeah. So what was the exactly for with the lifting of the heel? Calf strengthening and to see if you use those toes to grip the floor which you do. Okay. Which is why you have hammer toes.

Okay. Right because you're gripping the floor assisting yourself. I always think of toes like fringe on the carpet, they need to stay relaxed. And they're great for pushing off when you're walking but if they're over used, they end up like that. Okay.

Right, with that hammer toe position. Okay. Okay, so now what we're gonna do is look at extension. So I'm looking for at least 70 degrees of great toe extension for functional movement so we're gonna do some functional movements in a moment and see how that affects your foot, okay. So what we need to work on now is the great toe extension, that looks really good too and especially, it's like you're stretching the hamstrings of your toes I think of these like hamstrings and then you're stretching these out.

This is like your knee here and you're trying to get that to stretch. So one of my favorite things to do is a lunge or even a quadruped position. Alright now we're gonna have you come onto the mat and stand with your heels at the back edge of the mat here. This way, this side. And I want you to step pretty far forward onto the mat, Ill give you the dowel just to help you with your balance okay?

And step really far forward, there you go, good. Alright now, when you start to go down into a lunge, that back heel has to lift and you have to be able to bend through that back foot, right, that back toe. So you're gonna go up up up, straight up lift up tall, that's it so that's already the push off position so I also would love for her to be wearing the spacers with that and, yeah, you see your foot, a mirror is really good for clients so they're not bending over to look at their foot. So I'm gonna move your toe over and I'm gonna make sure I hold onto her, so that I don't knock her over so when she gets those into position let's see what happens. Now what I want you to do Candice is go down into a full lunge, putting your knee on the floor, excellent.

So I look to see can she keep the great toe the metatarsal phalangeal joint on the floor? And she comes off a little bit, now is that painful at all? No. Okay so she comes off a little bit, we need about 90 degrees in order to, to keep the toe down but as long as it's not too painful that should be okay for her. That limits a lot of people with lunging and so what I usually recommend, if people have pain or cannot get all the way down and keep the ball of the foot down, then they wear their shoes for lunges because then you can still do the lunges and not hurt your foot.

Alright so that looks good now come onto all fours and I'll show you a little stretch that will help. So yeah just getting into all fours you'll find that neutral position of your spine tail lifted a little bit and then I want you to sit back just toward your heels. Okay now, the other thing is if I just let her be in that valgus position of her toes, then I'm not gonna help the bunion very much so what I wanna do is come up, have her come up, I'm gonna go ahead and stick the toe spacers in there you can point your toes and let me stick 'em in there and. Right 'cause every opportunity I have to correct her alignment is what I want and so then that's gonna straighten her toe out and I wont accentuate the bunion 'cause some people let the feet roll in and then they just accentuate the bunion, that looks beautiful. Wonderful is that feeling okay?

Mhm. No pain, so you don't want 'em to have pain with it but gentle stretch and pressing back like that, good. That looks great. Alright Candice, do you mind coming up and forward and then turn around so that the back of your feet can be seen and we can see your cute little tush right (laughing) and then turn around all the way, exactly. And then you can see, the weight bearing across the metatarsal heads is even, I wouldn't want her to be like that, right, and I certainly wouldn't want her to be like this, with the heels close together, right, and that might be painful sorry.

(laughing) she's like don't do that. So yeah I wouldn't want the heels close together, I want that heel right above the toes when she does that. Okay come up and forward, alright and then come to standing. Turn around and let's see how the feet look alright I want you to try to spread your toes apart, this one looks great aha. And then, that also, that stretch also stretches the hammer toes of the second through fifth toes so that's really great, you wanna press down through those toes and actually lifting them up.

So when she presses down through those toes, it actually makes it worse so that's not the right cue for her. I think the better cue is to lift up. So that actually is better and then press down. So I think the wrapping of the foot around the bar is gonna be really good for her and in the reformer classes, on the tennis ball things like that. Okay great.

I see so right there is where I'm gripping and making it worse. Right, that makes it worse. Okay. Exactly, and so what you want is to have those as lengthened as possible and relaxed as possible, you don't wanna see those tendons sticking up and you also wanna try to get these to lengthen out and mostly it's relaxation that needs to occur. 'cause if you do something, they end up going back to that hammer toe position, right?

So that looks, they look a lot better, it looks great. Alright well done. Thank you. Okay so I wanna make a small mention about total knee replacements because I think, she doesn't have a total knee replacement but if you had a total knee replacement, a lot of times people will avoid going into a kneeling position and they think it's contra-indicative but it's actually not contra-indicated, that thing is bionic it's not going anywhere, it's nailed in there so it's usually the comfort level or fear of doing something to the knee replacement that is the issue so usually those people just need padding or something like that to help with cushioning the total knee replacement but it's not contra-indicated to go onto your knees. It's actually a great movement to do.

Then you can do five stretch which, five stretch is such a wonderful exercise for knees and a lot of people with knee pain will avoid the five stretch and what I like is getting into that position on the knees, really getting that length. I think of it being like a tug of war between the hip flexors and the abdominals so the hip flexors are winning, your pelvis will be in an arch. If the abdominals are winning, right, then you'll be in this neutral pelvis position. And then what that does is it gives you this lovely contract relax between the ASIS, the pelvis to the patellofemoral joint so it takes the stress off the patellofemoral joint so when people go back into that position there they'll actually get this stretch with a contraction which actually releases the muscle tension, may be a little uncomfortable while they're doing it but as long as they have relief of pain after they finish, you're in good, a good position. And also, one of the general rules of thumb about whether exercise is good or bad or flaring you up or something like that is if you have pain two hours after exercise.

If you have pain two hours that lasts longer than two hours after exercise, or doesn't get better two hours after exercise then you might have overdone it so you might need to back off on the next lesson. Okay thank you so much. Thank you. It was wonderful to work with you again. Thank you.