The Abductor Hallucis is a fusiform muscle located in the foot. Abductor hallucis comprises the first layer of muscles along with the muscles known as flexor digitorium brevis and abductor digiti minimi.
The primary function of the abductor hallucis muscle is to help in pushing the body forward during gait and to help in stabilizing the foot. The foot’s complex structure contains over a hundred tendons, ligaments, and muscles that stabilize or move over thirty joints in between the twenty-six bones, providing structure to support the body’s weight. Bones are designed to primarily support our body weight, while a small portion of the body’s support is provided by the surrounding and stabilizing soft tissue structures, among them the plantar ligament, the posterior tibialis muscle-tendon complex, and the abductor hallucis muscle and tendon.
Muscle or tendon strain / tear refers to microdamage to a muscle or its tendon. Muscle damage can be in the form of tearing part or all of the muscle and / or tendon fibers. The tearing of the muscle can also damage small blood vessels, causing local bleeding, hematoma, bruising, and pain caused by irritation of the nerve endings in the area.
In many cases, abductor hallucis strain is caused by long-standing repetitive micro-traumas imposed on the affected structure during the course of regular daily activities especially when one is affected by increased or excessive pronation; as the foot collapses during function due to repetitive inward, downward, and forward subluxation of the ankle bone upon weight bearing, excessive forces are shifted away from the skeletal structures up to the point where one or more soft tissue structures will get overloaded, inflamed, swollen, and tender.
Oftentimes, the condition may be induced by overuse, for example, sudden heavy lifting, sudden increase in sports activities, or while performing unusual work tasks. In some cases, abductor hallucis strains may result from footwear that does not properly work with the foot’s alignment or throws off the body’s natural weight balance.
Causes & Symptoms of an Abductor Hallucis Strain
As mentioned, the abductor hallucis muscle strain is generally caused by repetitive micro-traumas directly imposed on the structure during performing any regular activity that require excessive use of the foot. Therefore, some of the activities that can cause intense damage or strain the abductor hallucis muscle include the following:
Running on or ambulating on uneven surfaces (such as concrete, steel, or steep hills) can lead to straining your abductor hallucis muscle, since every step you take damages the arch of the foot first when landing. Walking when your feet are underwater can even lead to a strain due to the increased strength needed when taking each step.
Improper shoe size
Wearing a pair of shoes that are smaller than your regular size can result in a strain of your entire foot. This may also affect the plantar fascia, calcaneus, and the phalanges of your toes because of the size of the shoe tightening everything inside your feet.
Females who often tend to wear high heels are prone to injure and strain the abductor hallucis muscles. Additionally, wearing high heels for hours and hours of wear can constantly strain on the muscles, bones, and tissues in the feet and ankles, resulting in chronic foot pain or sudden injuries that may require further surgery.
Several symptoms of abductor hallucis strain may include pain, swelling (edema), redness (erythema), and bruising (hematoma) along the medial aspect of the foot’s longitudinal arch. Pain is present at rest and is worsened whenever the specific muscle or the joint in relation to that muscle is used. Some weakness within the strained muscle or tendon is often noticed. Other symptoms linked to abductor hallucis pain also include:
- Big toe joint pain especially when pushing off from the ground during the gait cycle.
- Medial plantar nerve entrapment due to the nerve being located directly underneath the muscle (this would be the most likely cause of sharp pain in the arch).
Pain and tenderness along the inside of the sole of the foot / arch when pressing down on the muscle.
Who gets an Abductor Hallucis Strain?
Even though abductor hallucis muscle strains can develop without an obvious cause, some risk factors can still increase your risk of developing this condition. The following factors include:
- Age – Abductor hallucis strain is most common in older adults over the age of 30 and beyond. Elderly patients are also at risk due to the general wear and tear of the arches (arthritis).
- Certain types of exercise – Certain activities that place a lot of stress on your heel and attached tissue (such as long-distance running, ballet dancing, and aerobic dance) can contribute to the onset of abductor hallucis strain.
- Foot mechanics – Flat feet, a high arch, or even an abnormal pattern of walking can affect the way weight is distributed when you are standing and can put added stress on the abductor hallucis muscle.
- Obesity – Excess pounds put extra stress on your abductor hallucis muscle, thus leading to straining it.
- Occupations that require standing excessively – Factory workers, teachers, and others who spend most of their work hours walking or standing on a hard surface can damage the abductor hallucis muscle.
How Does an Abductor Hallucis Strain Affect You? How Serious is it?
There are other medical conditions that can be caused by a strained abductor hallucis muscle – these medical conditions are:
A bunion is a bump that forms on the outside of the big toe. This foot deformity occurs from years of pressure on the big toe joint. Eventually, the toe joint gets out of alignment, and a bony bump forms.
Flat feet deformity
Flat feet deformity is a progressive flattening of the arch of the foot that occurs as the posterior tibial tendon wears down. This condition may progress from early stages with pain and swelling along the posterior tibial tendon to complete arch collapse and arthritis throughout the back of the foot.
Plantar fasciitis is a degenerative condition of the thick band of tissue at the bottom of your foot that runs from your heel to your toes. This condition causes pain in your heel, therefore, it’s typically worse when you take your first steps in the morning or after you’ve been sitting for a long period of time.
Recommended Treatment & Rehabilitation for an Abductor Hallucis Strain
It is always important to seek medical attention if you suspect symptoms regarding abductor hallucis strains. It is recommended to undergo a diagnosis if you hear a popping sound with the injury, cannot walk, or there is significant swelling and pain. Once you begin a diagnosis with your doctor, he or she will take a medical history and perform a physical and radiological exam.
During this exam, it is important to establish whether the muscle is partially or completely torn, which can involve a much longer healing process, possible surgery, and a more complicated recovery. It is also important to examine all of the foot structures since it isn’t unusual to identify one or two co-existing foot conditions (such as plantar fasciitis, Achilles’ tendinitis, and tarsal tunnel syndrome) that need to be taken into account in the process of future treatment plans by a physiotherapist.
A physiotherapist may want to further diagnose your injured foot before proceeding to any treatment plan. Therefore, to diagnose abductor hallucis strain, your physiotherapist may conduct the following physical tests to see if symptoms occur, such as:
- Massaging and pressing on the heel area, arch of the foot, toward the toes.
- Gently stretching the ankle to bend the top of the foot toward the leg (also known as dorsiflexion).
- Gently pressing the toes toward the ankle.
After you are diagnosed, your physiotherapist will work with you to develop a program to decrease your symptoms. Your treatments may include:
- Stretching exercises – Your physiotherapist will teach you how to do various stretching exercises to help improve the strength of supporting muscles in your foot.
- Assessment of your gait – Your therapist will work with you to improve how your walk and explain how this may impact your symptoms.
- Strengthening exercises – He or she will teach you a selective amount of strengthening exercises to improve the strength of your abductor hallucis muscles.
- Ice application – Your physiotherapist will be able to apply ice on your affected area to help decrease pain and inflammation. This will strongly reduce swelling and inflammation.
- Iontophoresis – Your therapist will order an electrical stimulation device known as iontophoresis to gently deliver medication through your skin and tissues.
- Orthotics and supportive footwear – Your physiotherapist will likely order orthotics for you to help minimize abnormal foot motion, or to help support your arch, reducing stress to the abductor hallucis muscle.
- Night splint – A night splint can be used to help you maintain correct ankle and toe positions while sleeping. This is equipment is highly recommended to avoid increasing restlessness.
During your physiotherapy session, your therapist will teach you ways to avoid worsening your abductor hallucis strain. Certain guidelines for the prevention of management of abductor hallucis muscle pain include the following:
- Choosing shoes with proper arch support and an appropriate heel height.
- Using a thick mat if you stand in one place for an extended period of time.
- Replacing your shoes regularly, before they wear out.
- Adjusting your exercise program to include a warmup to avoid straining your abductor hallucis muscle.
- Stretching your calves and feet before and after running or walking.
Exercising your affected foot is a great way to recover from your abductor hallucis pain whether it is at home or by your physiotherapist. Therefore, here are some exercise examples you can try at home or elsewhere:
Stand with the balls of your feet at the edge of a bottom step. Next, with your heels hanging off the edge, slowly and gently lower your heels just below the edge of the step. You may feel a stretch in your calf muscle. Lastly, slowly rise onto the balls of your feet, then repeat this method 10 times with 2 sets a day.
Ankle inversion with resistance
Sit upright on the floor with your legs straight out in front of you. Afterward, place your left leg over your right leg with a resistance band secured around your upper foot and looped around the bottom of your lower foot. Hold the end of the band in your hand, then slowly move your upper foot away from the lower foot. Repeat this exercise 10 times with 2 sets a day.
Seated toe towel scrunches
Sit upright in a chair with one foot resting on a towel and spread your toes. Curl your toes to scrunch and draw the towel toward you 10 times. Perform this method once a day with 2 sets per foot.
Alternative & Homeopathic Treatment for an Abductor Hallucis Strain
Typically, it may take several weeks to recover from a mild abductor hallucis strain. Therefore, you can do these homeopathic treatments at home to ease the pain and help your foot heal faster:
- Rest – It is important to keep weight off your foot until the inflammation decreases and the pain subsides.
- Icing – Applying an ice pack is an easy way to treat inflammation. To make an ice pack, wrap a towel around a plastic bag filled with crushed ice. Then, put it on your heel 3-4 times a day for 15-20 minutes at a time.
- Pain relievers – Non-steroidal anti-inflammatory medications (NSAIDs) can make your foot feel better and help reduce swelling and local inflammation. Pain-relieving creams are also a helpful alternative if you choose to not take pain-relievers orally.
- Athletic tape – Tape can support your foot and keep you from moving it in a way that makes abductor hallucis strain worse.
- Shoe inserts – Also called insoles, they can give you extra cushion and added support. You can get them over-the-counter or have them custom-made.
- Foot shower – Having a hot foot shower will help circulate blood flow where your foot is affected. Adding Epsom salt can boost your recovery much more.