I have been using these a bit lately. You know, you have a run of something in the clinic and then don’t see it for months. at the moment its using the carbon fibre plates for hallux rigidus.
I do have a bit of dilemma using them. Yes, they do work really well for hallux rigidus and pretty much every one that I have used them on lately has had a good outcome and that is supported by the evidence. However, I also know that they are going to interfere with the windlass mechanism and affect thing like Bojsen-Mollor high gear, low gear concept. We just do not know the long term impact of interfering with that. However, on the other hand, neither of those mechanisms is working too well becasue of the hallux rigidus. I guess this is just one of those occasions where you have to weigh up the options and make the compromise to get a good clinical outcome.
Personally, I prefer the ones that are more of a Mortons extension as that still does allow a somewhat more normal function of the lessor metatarsophaplangeal joints, so the compromises are not as much is the carbon plate covered the whole forefoot area.
No sooner did I write a post about the bunion correctors did I get an email asking me what I thought about exercises for bunions? I not a big fan and have a similar view to those I have of bunion correctors.
Think about the force that are creating a bunion. Think about the force that comes from the biomechanics and the forces that come from the shoes. Do you think a bit of muscle strengthening is going to fix that? Unlikely. Yet if you get online and search you see so many touting bunion exercises as the holy grail to cure bunions. You will notice that not one of them can point to a single study or a bit of research that supports their claims.
So does that mean bunion exercises are useless?
Not necessarily. There is no evidence that they can correct bunions and the mechanism by which they could is based on flimsy evidence or nothing, but should you do them?
I have been getting patients for years to do exercises for their bunions, but not in the expectation or hope that will fix them, but in the expectation that they will keep the joint mobile and flexible. That is a good thing. That does tend to help with some of the aches that happen in the joint.
What bunion exercises should you do?
I recommend this one, its a band around the toes and you pull the feet apart – it goes a long way to help the mobility of the joint and that helps the symptoms:
I seem to be writing a number of short sharp cynical posts lately and this may or may not be another one of the those. Because of my work, you get a lot of targeted advertising on Facebook and other social media sites based on websites I may have visited or posts that I engaged with. Obviously, a lot of stuff targeted at those with foot problems are going to show up to me. Some of that stuff is really bad and I have to try really hard to bite my tongue and not respond. I do have a habit of trolling flat earthers and pseudoscience peddlers but have leant from experience that if you troll those selling crap products, they just delete your post, so I think better of it.
Lately, I have had a flurry of promotional adverts turn up for these “bunion correctors”. I used to never think much of them. You are supposed to wear them at night and they are supposed to correct the angle of the hallux valgus. My opinion was always that during the day you have the force of the shoes and the force of the biomechanics creating the bunion or hallux valgus is way greater than the force that these bunion splints can provide during the night. That was my somewhat cynical view, so I did not put a lot of faith in them. But, they have been used for over 100 years and something that has been used for that long has to be good … right? You still do see a lot of people asking about them online.
But like any good clinician, you should stick to the evidence. And there is a study showing that they can correct the angle by a few degrees after a months use, so it does look like they may be able to help a bit. I probably should revise my opinion of them.
What I will not be doing is revising my opinion of some of the clowns that try to sell them and their before and after photos. Follow this series of photos that I screen captured of a website trying to sell them:
Its does not take a rocket scientist to notice that the before photo is the left foot and the after photo is the right foot and the shoe on the ground tells us that the photos were taken on the same day. And these photos were being used to tell us how great the bunion correctors were and to sell them. They must be pretty stupid to think people are that blind.
Like a lot of other topics (eg overpronation and supination resistance), I have a lot to say about the windlass mechanism of the foot. The windlass mechanism is the foot’s own natural way of supporting itself, so it is crucial that it functions well and there be nothing wrong with the way that it works. Interventions used to treat foot and lower limb problems need to facilitate rather than inhibit that mechanism
Podiatry Arena has a lot of valuable information and threads on the windlass mechanism including all of the research published over many years and I wrote about our research and all of the windlass dysfunctions at my running blog. I have just been tasked with sorting the windlass mechanism page at PodiaPaedia, so looking forward to sorting that out.