Question
i just got through watching a video in reference to a foot and bone chiropractor.  His demonstration referred to the bunion of the foot and how it is formed and the remedy without surgery.  The chiropractor can align the long bone and the toe bone where the shoe box creates the bunion due to the shoe structure.  My question is this.  If you have had this deformity for years, (40 to be exact) can the visit to a chiropractor align the bones and prevent the surgical procedure?

Answer
Gina,

Correction of a bunion by manual manipulation is not something with which I am familiar, nor something I would attempt.

Bunions are believed to be caused by mechanical stress, a possible genetic predisposition, poor fitting shoes, and as a result of various arthritic conditions. The big toe joint becomes enlarged and the big toe tends to deviate out to the side. I always refer patients with bunion problems to a podiatrist for evaluation and treatment.

In a nutshell, a literature search on this topic did turn up several pilot studies and case reports purporting some potential benefit from manual therapy in correcting bunions (without surgery). But several other critical analyses that looked at the quality of these studies concluded that there really isn't any high-quality evidence to support manual therapy as an effective modality for correcting bunions.

I have organized those studies (researched through PubMed, the government's database for peer-reviewed international medical research) below.

The bottom line is that based on the evidence I can find in the medical literature, podiatrists and orthopedic surgeons are best qualified to deal with bunions, not chiropractors.

I hope this helps to answer your question.

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Articles in favor of manual therapy for bunion correction:

1. A pilot study of the efficacy of a conservative chiropractic protocol using graded mobilization, manipulation and ice in the treatment of symptomatic hallux abductovalgus bunion. Brantinghama, Guiryb, Kretzmannc, Kitea, and Glob. Clinical Chiropractic. Volume 8, Issue 3, September 2005, Pages 117-133.

Objective: The study was a prospective, randomized clinical trial involving 60 subjects, 30 in each group, selected from the general population. Group A received a progressive mobilization of the first metatarsophalangeal joint, used in conjunction with cryotherapy and adjustment of all other fixations found in the foot and ankle. Group B received placebo treatment. There were six treatments over a two-week period and a one-week follow-up consultation.

Conclusions: In terms of objective findings, analysis of the treatment group revealed a statistically significant improvement in the pressure-pain threshold (algometer readings) at each treatment interval, whereas the placebo group had no statistically significant improvement for this measurement.

A statistically significant difference was noted between the treatment and placebo groups at the third, sixth and one-week follow-up consultations, for each measurement parameter assessed. This difference indicated greater improvement in the treatment group when compared to the placebo group, in terms of each measurement parameter.

It was concluded that this conservative chiropractic management approach was effective, in terms of objective and subjective measurements, in the treatment of patients suffering from symptomatic hallux abductovalgus (bunions). It was found that the placebo treatment was effective in alleviating the pain perceived by the patients in the overall treatment interval (NRS-101); however, this improvement was not substantiated by any significant improvement in the Foot Function Index (FFI) and the objective assessment of the patients?pressure-pain threshold levels.

2. Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: An exploratory randomised clinical trial. du Plessis M, Zipfel B, Brantingham JW, Parkin-Smith GF, Birdsey P, Globe G, Cassa TK. Foot (Edinb). 2011 Jun;21(2):71-8. Epub 2011 Jan 14.

Objective: The purpose of this exploratory trial was to test an innovative protocol of manual and manipulative therapy (MMT) and compare it to standard care of a night splint(s) for symptomatic mild to moderate HAV, with a view gather insight into the effectiveness of MMT and inform the design of a definitive trial.

Conclusion: The trend in results of this trial suggest that an innovative structured protocol of manual and manipulative therapy (experimental group) is equivalent to standard care of a night splint(s) (control group) for symptomatic mild to moderate HAV in the short term. The protocol of MMT maintains its treatment effect from 1-week to 1-month follow-up without further treatment, while patients receiving standard care seem to regress when not using the night splint. Insights from this study support further testing of MMT for symptomatic mild to moderate HAV, particularly where surgery is premature or where surgical outcomes may be equivocal, and serve to inform the design of a future definitive trial.

3. Manual therapy in the region of the foot : A narrative review. Ammer K.

Objective:  Aim of the study was to conduct a literature search to identify studies, which may support the effectiveness of manual therapy in the region of the foot.

Conclusion: On evidence level III, manual therapy is more effective than sham electrotherapy or sham ultrasound in hallux abducto valgus deformity, primary metatarsalgia and Morton抯 neuralgia.

There is still a lack of studies of good quality, which support the effectiveness of manual therapy in the foot region. It is concluded from this study, that manual therapy may rather increase the range of motion than reduce pain.

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Articles not in favor of manual therapy for bunion correction:

1. Effectiveness of manual therapies: the UK evidence report. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Chiropr Osteopat. 2010 Feb 25;18:3.

Objective: The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions.

Conclusion: Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.

2. Manipulative therapy for lower extremity conditions: expansion of literature review.
Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W. J Manipulative Physiol Ther. 2009 Jan;32(1):53-71.

Objective: The purpose of this study was to conduct a systematic review on manipulative therapy for lower extremity conditions and expand on a previously published literature review.

Conclusion: There is also a level of I or insufficient evidence for manipulative therapy of the ankle and/or foot combined with multimodal or exercise therapy for hallux abducto valgus.

3. Chiropractic treatment of lower extremity conditions: a literature review. Hoskins W, McHardy A, Pollard H, Windsham R, Onley R. J Manipulative Physiol Ther. 2006 Oct;29(8):658-71.

Objective: The purpose of this study was to document the quantity and type of research conducted on the chiropractic management of lower extremity conditions.

CONCLUSIONS: Literature on the chiropractic management of lower extremity conditions has a large number of case studies (level 4 evidence) and a smaller number of higher-level publications (level 1-3 evidence). The management available in the peer-reviewed literature is predominantly multimodal and contains combined spinal and peripheral components. Future chiropractic research should use higher-level research designs, such as randomized controlled trials.