Big Toe ROM (range of motion) Exercises

Stiffening of the big toe joint after bunion surgery can best be reduced by performing daily stretching and range-of-motion exercises of this joint. ROM exercises are important to achieve the best results after surgery. ROM therapy will help prevent stiffness and adhesions (scarring) thereby aiding in a quicker recovery and improved shoe style options. This very important part of the recovery process depends on your willingness and attention. If during your recovery you are having difficulty performing your exercises, please consult Dr. O’Connor.

Begin mild, assisted range-of-motion exercises. Grasp the big toe near the base of the toe close to the big toe joint. Do not mistake the big toe joint for the interphalangeal joint. The interphalangeal joint is the joint in the middle of the big toe, closest to the toenail. Gently flex the toe upward until resistance is met and mild discomfort is experienced. Then hold for approximately 5 seconds. Perform this 10 times; then flex the toe downward in the same maneuver for 10 sets of 5 seconds each. This series of exercises should be performed 3 times a day after the first visit. During this period the same manually assisted range-of-motion exercises should be increased to approximately 6 times per day with a gradual increase in vigor and force applied to the toe each day as tolerated.

After 2 Weeks, begin gravity assisted and weight-bearing exercise programs. This is performed by lifting the heel up, keeping the big toe on the ground and using body weight to force flexion at the toe. Stand on the toes for approximately 10 seconds at a time as tolerated. In addition, you may also implement the distraction and manipulation-stretching program.

Distraction and Manipulation Exercise

Grasp the forefoot with one hand just behind the big toe joint with the thumb on the top of the foot. With the other hand, grasp the big toe at the base close to the big toe joint.

- First, distract the big toe as the arrows illustrated in figure A.

- Then, while stabilizing the forefoot with the thumb of the first hand (figure B), push the big toe upward with the second hand without bending the toe (keep toe straight).

- Hold for approximately 10 seconds and repeat 3 times.

- Perform the same maneuver by pushing the big toe downward, keeping the toe straight as illustrated in figure C.

- Hold for approximately 10 seconds and repeat 3 times.

This exercise regimen should be done approximately 6 times a day in addition to the range-of-motion exercises.

It is important to keep in mind that postoperative swelling can persist for 6 months or longer after bunion surgery, and the ability to wear tight shoes or fashionable women’s shoes is very difficult when swelling and stiffness are present