This topic contains 5 replies, has 5 voices, and was last updated by 
William Brady, DC September 15, 2016 at 10:03 am.
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AnonymousI had a patient that has bunions and asked me if I could help her. I told her that I would get back to her after reaching out to the ID community.
Is there anything we can do as ID docs?
What history questions should I ask?
What should I listen for?
What tests can I perform?
What treatment can I provide?
Who can I refer her to if need be?
Thank you for the support
Carl Nottoli, DC
As ID practitioners we look at problems very differently so if someone calls with a musculoskeletal complaint then you should be able to help. Think of your skill set in 3 different categories, not just manual therapy: 1) diagnosis 2) manual therapy/exercise 3) load management/proper referral
In regards to your specific case follow the general history taking video that was posted recently. Age and sex, then the 5 specific questions to get more information of the chronicity and severity. The patient’s age along with the other 5 questions will give you a really good prognosis right out of the gate.
As far as tests–run them through level 5 DF, PF, Lockout if needed. In addition, perform passive toe extension while lying supine. A healthy toe should move 90 degrees. A person with a bad first toe absolutely needs stellar DF and PF to save the joint.
After collecting all the data you should be able to narrow down how much you can help. If this patient is behind conservative care, they now have a complete diagnosis and know where to go next. Generally speaking, foot/ankle orthopedists have better skills than podiatrists if surgical consult is the next step.
This should get you started. Let us know if you have any further questions.
Andrew Wengert
I had this same question on a coaching call. Treat the bunion as the irreducible block that it is. Treat the degenerated toe like you would a degenerated disc. Respect that pathology and restore all the function you can with treatment and strength exercise. If you hit a plateau, refer out accordingly. So pretty much what Carl said.
AnonymousThank you Carl and Andrew. I appreciate you taking the time to help me on this case.
Ryan Pribble
I would also evaluate for sole supports. Their logic for why a overpronated foot can cause a bunion makes sense to me.
William Brady, DC
Great answers! You guys nailed that. I have nothing to add 🙂
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