By Dr. Steven Gershman
What is a Bunion?
The medical term for a bunion is "Hallux Abducto Valgus “, or just "Hallux Valgus”. It is a deformity of the big toe area of the foot including a bump on the inside or medial side of the foot, just behind the big toe on the first metatarsal head with a corresponding angulation of the big toe toward the second toe. Sometimes the big toe actually overlaps the second toe or goes under it. The "bump" is actually the first metatarsal head as the first metatarsal has shifted out away from the foot, widening it. In addition, the bump can enlarge due to inflammation from shoe pressure rubbing on it. Bunions can cause pain from inflammation, poor shoe fitting, balance issues from biomechanical changes in the foot from the altered anatomy and other problems.
How Do Bunions Occur?
Generally, bunions are a result of biomechanical flaws in the foot that are genetic/congenital. It is common to see bunions go from generation to generation, most commonly in women. Women are more prone to bunions due to generally more flexible joints and ligaments, including in the foot. This resulting increased motion allows any biomechanical flaws to be exacerbated causing shifting of the bones and then bunions. Women's ligaments are more flexible due to the necessity to give birth. Also, women's shoes can be an issue. While shoes alone don't create bunions, shoes can amplify the underlying biomechanical flaws. Dress shoes, high heels, pointed toe box, slip on shoes etc. are all culprits. Shoes and their effects will be discussed later in this this blog. In addition, arthritis and other joint and connective tissue disorders can add to bunion formation.
How to Prevent Bunions
The simple answer is bunions cannot be prevented! However, the speed of formation and severity of deformity can be affected and slowed. Preventing bunions is really not possible as soon as we wear shoes, especially those that are not designed properly. The underlying biomechanical issues we are born with are potent and cannot be changed easily. Once we put shoes on at a young age, we fundamentally change the shape and biomechanics of the foot forever. It’s like orthodontia for the teeth. Shoes immediately put pressure on the forefoot forcing the toes together and pushing the big toe inward changing the anatomy including shape of the bones and cartilage location. Looking at pictures of feet in some societies that never wear shoes show feet that look dramatically different than the feet that wear shoes. Without shoes, the toes are separated in a way that looks like a hand. Good shoes that have been designed with the foot and biomechanics in mind, will not have a significant impact.
Although preventing bunions is not possible, shoes can and do affect the severity of the anatomical changes that occur in bunion formation and the associated symptomology. Basically, the more the shoe forces the big toe toward the second toe and allows excess motion, the worse the deformity. Narrow pointed toe box shoes are a major factor. Unfortunately, many woman's shoes are shaped that way for "style". High heels are particularly damaging as they force the foot into an altered biomechanical position and jam the forefoot and big toe into the floor shifting its position.
As noted above, excess motion in the foot is one major cause of bunions and the reason more women have bunions. One cause of excess motion is over pronation. Pronation is a natural motion the foot goes through as we walk and stand that loosens the foot. Pronation rolls the foot inward and drops the arch. This allows shock absorption and adaptation to changes in terrain so the foot can deal with uneven surfaces. Over pronation is a common issue in many foot problems. We can treat over pronation and the resulting excess motion it causes with orthotics in the shoes. Orthofeet manufactures a well-made over the counter orthotic, that is designed to support the arch, control over pronation, align the foot and correct the gait. I use a lot of these in practice and they have helped my patients tremendously. In more severe cases, a true rigid custom orthotic is required. Although there is no definitive proof of this, it is believed by many podiatrists that orthotics started early can significantly alter the severity of bunions and slow down the progression.
Orthofeet offers several types of orthotic insoles to fit different shoes and activities. To learn more and view the collection click here.
Shoes for Bunions
In addition to orthotics, shoes are the other significant factor in bunion formation and severity. As noted above, shoes that have a narrow or pointed toe box are a major factor in speeding up and increasing severity of bunion formation. The best bunion shoes should be designed with the following features:
- • Shoes for bunions need to have a wide, round, and high toe box. The less pressure on the big toe, the better. Orthofeet shoes have a very round deep toe box with lots of room. I wear them myself due to the comfort factor and since members of my family had severe bunions and I have the excess pronation and motion that could form bunions.
- • If you already have bunions, the best shoes for bunions have the round toe box with extra depth for the big toe, often being over or under the second toe. Also, extra depth shoes are critical to add to stability and reduce motion and can easily accommodate orthotics.
- • Wide or extra wide shoes also are critical for bunions. Most shoes found today in big box stores only carry one width, usually medium, which is far from what a bunioned foot needs. The good news is that specialty footwear brands such as Orthofeet design shoes in extended widths from narrow all the way up to extra extra wide! In many cases, bunion relief of pain is as easy as wider shoes with a round toe box. Learn how Orthofeet shoes can help with bunion pain relief here.
- • The material of the shoes is also critical for feet with bunions. Shoes constructed with tight and unforgiving materials will apply pressure on the bunion and worsen the condition and cause pain. However, shoes made with stretch knit uppers offer 4 way stretch and conform to the contours of your foot, specifically the bunion, to create a pressure free fit. Supple leathers can also work well. I have many patients with very wide feet from bunions wear these after failing in most other shoes. Orthofeet manufactures many shoes that stretch and accommodate even most of the worst bunions. To view Orthofeet stretchable bunions shoes click here.
- • Shoes for bunions should have a low heel or be flat to the ground to avoid forcing the forefoot into the floor, such as is the case with heels. Orthofeet shoes have an ergonomic sole with mild rocker bottom that facilitates foot motion and transfers weight evenly from the rearfoot to the forefoot.
How to Stretch Shoes for Bunions
Although not my first choice and not as effective in treating and preventing bunions, there are some who like to stretch shoes to accommodate the bunion. There is an excellent blog on the Orthofeet site "How to Make Shoes Wider for Bunions”. The blog gives information that is useful for home accommodation of bunions and thus reduce foot bunion pain. But note this paragraph:
Note that while stretching your shoes is helpful, the best solution for people with bunions is to buy special shoes for bunions, like Orthofeet’s bunion shoes, which come with a wide toe box, soft stretchable uppers, and special orthotic insoles that provide arch support, reduce overpronation and help straighten the toes. Whether you’re looking for women’s shoes for bunions, walking shoes for bunions, the best bunions shoes for men, or any other shoe for bunions including extra-wide women’s shoes for bunions, you can find them at Orthofeet.
The one useful device I have in the office to accommodate for the large bump of the bunion on the side of the foot is the "ball and ring stretcher “. This device pushes out the toe box in one spot only, directly over the bump. Most podiatrists have this device and will be able to stretch your shoes if you bring them in.
Other Bunion Relief Options
Minimizing pain and providing relief is key if you have a bunion. Other options are available for those that have minor cases of the condition.
- • Bunions Socks: Bunion socks are not a means to prevent the deformity, but they can provide added benefits such as separating the big toe from the remaining toes. This ensures the toes do not overlap and rub against each other causing irritation. Orthofeet also offers these socks and they are super comfortable as they are made with soft bamboo fibers, offer a non-binding fit and wick moisture away from the foot.
- • Bunion Pads: If you are looking to protect the bunion from anything that touches and rubs against it, bunion pads can help. Note that some pads are medicated with acid in them that can burn the skin. Do not use these! Simple protective pads will do the job just fine.
See your podiatrist for more information and help with bunions. In the worst cases, surgery can correct bunions permanently. Surgery is the only true bunion corrector as it gets to the root of the problem.
Bunions are very common, and I hope this article helps you understand more about how to deal with bunions.
For more information on bunions, I recommend reading the additional blogs: