What You, Especially Runners, Should Know About the” Rest of The Story.”
You most likely were not born with bunions. They typically developed over time. Bunions develop from what is thought to be abnormal forces upon the big toe joint. Yes, stilettos and tight shoes can enhance them, but are the shoes the real cause?
Most believe bunions (hallux abducto valgus-hav) develop from abnormal biomechanics, yet some claim it is not a biomechanical problem. If not, then why are most bunions worse on one foot than the other? Both feet are used the same. If it really were the shoes (that are symmetrical), wouldn’t the bunions be identical? Both clinically and on x-ray, many bunions are not alike left to right.
Why are bunions painful?
Could it be the shoes? Of course, a less than ideal fit shoe can lead to excessive pressure in and around the joint. This is especially the case with runners if the foot slides forward jamming the big toe. This can lead to inflammation and pain. It is important to look for the ideal fit – not too much tapering in the toe box, with appropriate width and length.
“Well woman get bunions more than men, so it must be the shoes?”
This is not necessarily the case. Consider the hormones. Research has shown hormones do affect our ligaments, etc. Shoes can enhance or aggravate the bunion. However, not all women wearing these so called “bad” shoes develop bunions.
Do high heels cause bunions? Long term use of high heels may cause tightening of the Achilles tendon which can cause abnormal foot adaptions, such as flattening of the arches leading to bunion formation. Is this evidence a bunion is caused by abnormal biomechanics instead of shoes??
Should I wear Minimalist Shoes?
Some runners avoid shoes that have a little tilt forward or “lift” to avoid tightening the Achilles tendon. They claim you can train to a zero drop to prevent this. Some can accomplish this, but short of surgery, many of us have tight achilles that will not stretch out no matter what you do. Therefore, training everyone to wear zero drop shoes can lead to failure. In fact, it can lead to other problems. As a result, the barefoot “fad” did not turn out like some had claimed it would. If you are considering a minimalist shoe, it is best to consult a specialist first because there are not only functional considerations, but also structural as feet are different.
Are bunions hereditary?
In most cases, the answer is no, not directly. What is hereditary is the structure of ALL the joints and muscles in the feet. Any “abnormal” alignment can cause the big toe joint to function abnormally leading to the development of the bunion (hallux abducto valgus). It is not just because mom and grandma had them.
Can I develop bunions because my muscles are weak?
Indirectly, yes. Abnormal pull (tension) and compression may cause an imbalance of all the muscle tendon units about the big toe joint. So, over time, some may be weak and loose, some may be over strong and tight. So, strengthening and stretching may help, but it does not really address the main cause.
Can Shoes Weaken Muscles?
Some will say that shoes weaken our muscles, leading to the bunion. Well, some may weaken with shoes, but as we all must wear them, there’s little mention about how shoes can strengthen feet. Shoes may also realign the muscles to provide a more ideal performance. Furthermore, as we all wear shoes then why do we not all get bunions?
Of course, a narrow-pointed toe can prevent normal muscle function. However, the shoe is not the primary reason. Some will say it is. Some claim our toes are spread out as a baby and the shoes start deforming the foot early on when we put them in “adult” shoes. However, many infant toes are not spread out at birth. If my baby were born with toes appearing like some of the drawings of toes spread out claiming such, I’d be a little concerned about neurological issues.
So, as a shoe can enhance a bunion, little is said about the other main aggravating factor – the flat floor or flat inside of the shoe. The flat floor deforms our feet. Our feet are of all different shapes and positions (high, low, etc.). Yet, they are all going to try and deform to the same flat surface? This flat “surface” adaption will cause significant problems for some.
Some researchers, who typically mainly study runners, will say alignment doesn’t matter. This is said because they cannot prove or present evidence that proper alignment prevents injury. They speak very little about other factors such as long-term osteoarthritic damage to joints. Even though the arthritis is developing, it may take some time to start hurting. Therefore, just because it is not proven, does not prove it does not occur. Overall, if a shoe is too tight then it may aggravate or enhance a bunion formation and weaken muscles, yet again, the shoe is not the primary cause.
What about the shoeless societies?
Some claim they never suffer foot problems like bunions, hammertoes and plantar fasciitis? They claim our shoes may alter an otherwise normal gait (whatever “normal” is?). Well, these shoeless societies are not chronically weight bearing on flat hard surfaces. They are on grass, dirt, etc., surfaces that vary. This allows their feet and legs, etc. to function in a variety of ways. This utilizes many muscles in varying ways, so of course they may have stronger feet. However, put them on our hard-flat surfaces all day long and they’ll most likely develop problems like “us.”
Some will also say feet are adaptable. Therefore, you can retrain your feet to go barefoot avoiding all the bunions, etc. Okay…but not so for all on a hard-flat surface. For example, can any lineman in football train to be a wide receiver with training? No, because we are all different sizes and shapes with different alignments affecting not only function but also structure.
So, should treatment for bunions start with changing your shoes?
If they are too tapered, too short or too narrow, then yes. However, it is important to remember that faulty biomechanics are usually the cause of bunion development. Addressing the footwear and the faulty biomechanics will lead to an increased probability of eliminating pain.
David J. Sables, D.P.M., C. Ped.
Former Podiatric Surgeon Specializing in Biomechanical Care for Children and Adults