Bunions & Heredity

This video, featuring Dr. Ray McClanahan, a sports podiatrist at Northwest Foot and Ankle the inventor of Correct Toes, answers several questions that we at Natural Footgear are frequently asked:

Are bunions hereditary? Is there a way to prevent bunions from forming? If I already have a bunion, do I need to have surgery to correct it?

In a lot of cases, people assume they are predisposed to developing bunions because their older relatives developed bunions. But it's impossible to state that bunions are hereditary if all the members of one's family have worn shoes with tapering toe boxes. Shoes with this injurious design element hold the big toe in a bunion configuration for prolonged periods and are the direct cause of bunions in most people. Some individuals may have differences in the plasticity and elasticity of their soft tissues that make bunions more likely to occur when wearing conventional footwear, but very few (if any) people actually possess a genetic component that directly causes bunions.

Ill-Fitting Footwear: The True Underlying Cause

We are not born with bunions. It's only after adopting shoes with tapering toe boxes that this deformity begins to manifest. Footwear, beyond the earliest years of life, is not designed for a normal human foot. In fact, the current system for determining proper shoe width (Brannock Device) fails most people because it assumes that the foot should be widest at the ball, not at the ends of the toes.

Most footwear on the market today is not compatible with natural foot health and does not respect normal foot anatomy. In the above video, Dr. Ray makes the point that cultures around the world have deformed their bodies for the purposes of beauty and/or the psychological need to fit in. In our society, we often wear foot-deforming footwear to fulfill a societal ideal, notes Dr. Ray.

Dr. Ray, in the video, also mentions a terrific article written by Dr. William Rossi, a naturopathically-minded podiatrist, that discusses the topic of fashion and foot deformation. This article delves deeper into the psychosocial reasons that we willingly (and often unknowingly) adopt foot-deforming footwear and how this compares to other cultures' use of body-deforming practices.

An Illuminating Anthropological Study

An interesting study relating to the topic of bunions and heredity was published in the American Journal of Physical Anthropology in 2005. The study, conducted by S.A. Mays, examined the condition called hallux valgus—an abnormal deviation of the big toe toward the midline of the foot; something generally considered the precursor of a bunion—in two series of medieval skeletons: One series from the earlier Medieval period, one series from the later Medieval period. Here is the abstract from the study:

Hallux valgus is the abnormal lateral deviation of the great toe. The principal cause is biomechanical, specifically the habitual use of footwear which constricts the toes. In this study, descriptions of the anatomical changes of hallux valgus from published cadaveric and clinical studies were used to generate criteria for identifying the condition in ancient skeletal remains.

The value of systematic scoring of hallux valgus in paleopathology is illustrated using two British skeletal series, one dating from the earlier and one from the later Medieval period. It was found that hallux valgus was restricted to later Medieval burials. This appears consistent with archaeological and historical evidence for a rise in popularity, during the late Medieval period (at least among the richer social classes), of narrow, pointed shoes which would have constricted the toes.

Using ancient skeletal remains, this study makes the point that, before people started adopting toe-constricting footwear, toe alignment—including alignment of the big toe—was better. It's a common sense conclusion that's relevant to the discussion at hand regarding bunions and heredity. You can read the full study here.

Strategies for Preventing Bunions

Given that bunions are a progressive dislocation of the big toe's metatarsophalangeal (MTP) joint, and given that bunions are not hereditary, what's the best way to prevent them from occurring?

The answer is simultaneously elegantly simple and frustratingly challenging. Elegantly simple because the solution—avoid offending footwear—is clear and unambiguous. Frustratingly challenging because of the relative dearth of footwear options that offer you, the wearer, the ability to realize optimal toe splay, unimpeded by the toe deforming effects of tapering toe boxes (thankfully, as time goes by, there are increasingly more decent options are available to consumers—a positive trend that we hope continues).

The truth is that the bunion formation process begins early in life, with the adoption of footwear that squeezes the forefoot and (usually painlessly) pinches the toes together. With the toes held in this unnatural configuration for prolonged periods during the developmental phase of life, foot tissues maladapt and begin to hold this unfavorable configuration even when the offending stimulus (conventional footwear) is removed. Most of us continue wearing footwear that is not shaped like an actual human foot during adolescence and throughout our adult years, further reinforcing the toe deformities that began to manifest in early childhood.

In our experience, we have found that there are four main things you can do to help prevent bunions:

1. Understand and accept that the widest part of a normal and natural human foot (in both children and adults) is at the ends of the toes.
2. Select men's or women's foot-healthy footwear that has a wide enough toe box wide to allow for optimal toe splay.
3. Use the Shoe Liner Test to confirm that your footwear selection will indeed support the true shape of your foot in its optimal, splayed-toe configuration.
4. Exercise great discipline by using only foot-shaped footwear (as much as possible) for the rest of your life. Most people find that, once they make the switch to sufficiently wide toe box footwear, they have little desire to revert to the tapering toe boxes of conventional footwear.

If you have kids, you are in the best possible position to give them the gift of lifelong foot health (or at least a really great start in life in terms of their foot form and function). This video goes into greater detail about how to choose foot-healthy shoes for kids.

Ways to Reverse an Existing Bunion

When it comes to bunions, the simplest and most effective approach is always to prevent them from occurring in the first place. However, most people only discover later in life, after a bunion has already formed, that this foot problem can be easily avoided. It's an unfortunate scenario, but it is exceedingly common. And so, the question then becomes: What can be done to help reverse an existing bunion and achieve a more optimal toe alignment and foot configuration?

In our experience, we have found the following five steps to be very helpful in addressing an existing bunion (regardless of the stage of bunion development) and rehabilitating the feet and toes:

1. Select and adopt footwear that passes the Shoe Liner Test. In order to reverse your bunion deformity, your shoes, boots, sandals, and other footwear must be widest at the ends of your toes. Footwear that's touted as “wide” may not be sufficiently wide where you need the width the most (i.e., at the tips of your toes), so bear that in mind when shoe shopping.
2. Wear Correct Toes toe spacers on a daily basis, especially when weight bearing, to help gently shift your toes (including your big toe) back in line with their corresponding metatarsal bones. You can increase the degree of toe splay offered by Correct Toes over time by either sizing up (if applicable) or performing a few key customizations to the device. Other footgear that can be helpful in addressing an existing bunion includes Injinji toe socks and Pedag metatarsal pads.
3. Incorporate the Big Toe Stretch and foot strengthening exercises into your daily foot care routine. This video presents some additional helpful bunion reversal strategies that you can employ to straighten your big toe. Also, in our experience, we have found that BlackBoard ToeBands are an excellent tool to use in correcting an existing bunion and improving toe mobility.
4. Accept that natural approaches to bunion correction will take some time. Remember, your bunion did not form overnight, and so too will it require some time to restore optimal big toe orientation.
5. Document your progress by snapping a picture of your foot and bunion (from above, while standing) before you begin your bunion reversal program. Sometimes it may tough to assess the degree of change in your big toe angle, but having images to look back on should illuminate just how far you've come if you've been disciplined in applying the above strategies. Use a consistent background/surface for your images so that you can better assess the changes that have occurred.

Most people with bunions who adopt the above approaches experience at least some degree of bunion correction over time (in many cases, full correction). One scenario in which a bunion may not undergo progressive reversal using these strategies is when the big toe's MTP joint is fused and the big toe itself no longer has any appreciable range of motion. In cases such as these, surgery may indeed be a viable option, followed, of course, by the implementation of the natural approaches discussed here to prevent a recurrence of the bunion.

Bunions: Not a Foregone Conclusion After All

In the video at the top of this article, Dr. Ray concludes that bunions are simple to address if you understand proper foot mechanics and the role of footwear in the onset of this problem. Surgery is rarely the best option for a bunion (recurrences are common), and bunions truly are preventable if you understand their underlying cause and take appropriate steps to safeguard yourself.

Bunion prevention begins in childhood with the adoption of appropriately foot-shaped footwear, and so it's incumbent upon parents to understand the importance of natural foot alignment and then secure the best possible footwear for their children. In order to ensure foot health throughout your own lifespan, it's important to apply the same principles you use in selecting your children's footwear when selecting your own footwear. The key is finding footwear that allows your foot to function like a healthy bare foot inside your shoe in addition to adopting other essential footgear and performing helpful foot care exercises.

If you have any questions for us about this article, please feel free to leave a comment in the comments section below or reach out to us via our contact form. Here's wishing you straight, splayed toes and a bunion-free life!