Hallux valgus is a condition in which the big toe deviates towards the other toes and in some cases cross over the second toe.  It often occurs in association with a swelling on the ball of the big toe called a bunion.  The causes of hallux valgus include

• Genetic makeup
• Poor fitting footwear – toe box is too small
• Flat feet – can be congenital or acquired
• Excessive pronation of foot in gait
• Secondary to rheumatoid arthritis

Symptoms of hallux valgus

• Pain and swelling around the ball of the first toe
• Pain aggravated by weight bearing and tight fitting footwear

What you can do

• Inserting a 10mm thick piece of foam between the first and second toes to separate the toes
• Protecting the bunion by making an ‘o’ shaped piece of padding to cover it

What we can do

• Massage, stretching and joint mobilisation to rebalance muscles controlling position of big toe
• Improve mobility of big toe
• Advise on use of orthotics
• Improve biomechanics of foot to reduce excessive pronation

Mortons neuroma is caused by compression of one of the interdigital nerves that run between the metatarsal bones (the long bones in the middle portion of the foot).  The primary symptoms are a burning pain and numbness on the ball of the foot.  Compression of the nerve can be due to a variety of causes.

• A neuroma or benign (harmless) growth on the nerve
• Footwear – high heels or shoes that are too tight
• Activities that involve spinning on the ball of the foot such as golf and tennis
• A high arched foot
• Flat feet
• Increased body weight
• Excessive pronation (rolling in of the foot in gait)

Symptoms

• Burning or throbbing pain on one side of a toe and the adjacent side of its neighbour (most common under 3rd and 4th toes)
• Sensation of pebble in shoe
• Pain is aggravated when the forefoot is compressed/squeezed
• Pain aggravated by weight bearing
• Callus in same location as pain

What you can do

• Rest and reduction of activities that necessitate spinning on the ball of the foot
• Use a metatarsal raise that will spread the bones of the forefoot taking the pressure of the nerve
• Wear appropriate footwear
• Wear orthotic if feet are flat
• Decrease weight

What we can do

• Analyse and give advice on gait – i.e. assess if there is excessive pronation when walking/running
• Tape the foot to take the pressure off the nerve
• Give exercises to strengthen the arch of the foot (if feet flat)

Metatarsalgia is a condition affecting the joints between the metatarsal bones and phalanges more often in the second, third or forth toes.  In normal gait we push off from the big toe.  If there is a dysfunction of the big toe we change the way we walk putting more force through the ball of the foot around the second, third and forth toes leading to overstrain of the structures.  The condition is caused by

• First toe dysfunction: shortness, mal-alignment, excessive rigidity or flexibility
• A high arched foot (pes cavus)
• Rigid mid-foot joints
• Over pronation of the foot
• High impact activities (running, jumping and dancing)
• Trauma
• Tight extensor tendons of the toes

Symptoms

• Pain in the forefoot usually of gradual onset
• Pain is aggravated by weight bearing.
• Pain and tenderness aggravated by pressing on the ball of the foot.
• Pain aggravated by extending toes (bending toes up)
• Excess skin or calluses under the foot due to excess pressure.
• Swelling under ball of foot

What you can do

• Padding to protect the foot and re-distribute weight on the foot.
• A gel type shock absorbing and cushioning insole can be worn.
• Footwear with a wide toe box can help.
• Take anti-inflammatory medication (speak to doctor or pharmacist first)

What we can do

• Treatment to modify big toe mobility and alignment
• Mobilisation of joints to improve movement of midfoot
• Massage to reduce tension in extensor muscles on top of foot

Further Treatment options

• Corticosteroid injection into the foot to reduce inflammation.
• X-rays can indicate the amount of degeneration or wear and tear in the joint.