Auteur: Podiatre Montreal
What are the best orthotics to relieve bunions?
A number of well-designed studies have shown how orthotics should be made to better relieve bunion pain and tension in the big toe joint. Unfortunately, most of our patients who have had orthotics made for their bunions or big toe problems have orthotics that do not sufficiently relieve the tension in the joint and thus lead to an increase in problems.
How should orthotics be made to relieve bunions and joint pain in the big toe?
In 1996, a study conducted by Scherer showed that in order to better relieve bunions and pain in the big toe joint, an orthosis must orient the first metatarsal of the bone towards the ground. Scherer’s study (and other studies) showed that orthoses that hold the foot in this position better reduce tension in the big toe joint, a tension that can lead to bunions, arthritis and pain. Over time, this tension can lead to bunions, hallux limitus and hallux rigidus.
To avoid this kind of problem, orthoses should be prepared from a cast of your foot with your first metatarsal facing down, then the orthosis should adhere very strongly to the arch of the foot . By adhering almost tightly to the arch of the foot, the orthosis prevents the ground from putting pressure on the first metatarsal. This type of orthosis is called a “strong adhesion orthosis”.
Why don’t many types of orthotics work to treat bunions and joint pain in the big toe (hallux limitus)?
Many types of orthotics don’t work well for bunion pain (and other major foot problems) because they are not arching well enough and don’t adhere to the arch of the foot. When this happens, the foot may flatten over time. This leads to increased tension under the first metatarsal and then increased pressure in the big toe joint as you walk.
The importance of high-grip orthotics has been demonstrated in several rigorous studies. In particular, a study conducted at Dr. Washington University showed that if you need orthotics to treat toe pain, you need to be absolutely sure that they are made correctly and adhere very well to your arch.
The basics of preparing orthotics for bunions and joint pain in the big toe :
- The casting or laser scanning of your foot that is used to make the orthotics must be done without loading. If the foot supports your weight while the casting is being done, the brace will have a flattened arch and will be less effective in reducing pressure on the toes.
- Your doctor MUST place your foot in the correct position during the casting process. Casting can be done with plaster or laser scanning. It is imperative that the Podiatrist himself or herself perform the casting of your foot. A proper cast is essential and if a medical assistant takes the cast instead of the doctor, you must go to a different Podiatrist. A proper cast is essential for a good result and takes a long time to learn how to do it properly.
- The Podiatrist must write a prescription for orthotics so that the orthotics laboratory can make the orthosis so that it will adhere to the foot in a virtually waterproof manner. If your doctor’s prescription does not specifically state this, it is likely that the orthotic will not adhere properly and will not relieve the pressure on your toes.
- The doctor must use a very high quality orthotics laboratory. The quality of orthotics varies greatly. Many orthotics are less hollow than they should be to avoid any possibility of the patient complaining of irritation to the arch of the foot. Irritation of the arch sometimes occurs with strong adhesion orthotics, but a good Podiatrist will be able to correct this with a simple adjustment. If they cannot adjust them, you need a Podiatrist with more expertise in the orthopedic field.
Do all people with bunions need orthotics?
Not at all. In fact, we often recommend starting treatment with over-the-counter foot supports. However, foot supports do not adhere as well to the arch of the foot as custom-made orthotics, so they will not reduce pressure on the toes as much. Like custom-made orthotics, prefabricated orthotics work best in relieving tiptoe pain if they are more arched. We list the best prefabricated orthotics and other home treatments for big toe joint pain here. The best type of over-the-counter foot support for bunions is medical grade. Firm, hollow supports are best in relieving the pressures that cause damage to the big toe joint.
Why are so many bunion orthotics not made properly?
Unfortunately, orthopedic treatment is not regulated as it should be. Many physicians who provide orthotics are well trained in orthopaedic therapy (as they should be). At the same time, many of them are not aware of the latest research in the field of orthopaedic therapy.
If you are experiencing pain in the tips of your feet and would like to have them examined, make an appointment and come see us at our podiatry clinic in Montreal. If you already have orthotics, bring them with you so we can examine them.2021