A bunion, medically known as hallux valgus, is a bony bump that forms on the joint at the base of the big toe — the metatarsophalangeal joint. It occurs when the big toe pushes against the adjacent toe, causing the joint of the big toe to become enlarged and protrude outward. Bunions can be painful and may cause swelling, redness and discomfort, especially when wearing tight or narrow shoes.
The exact cause of bunions is not always clear, but they’re often associated with wearing tight or ill-fitting shoes, genetics or certain foot conditions such as flat feet or arthritis. However, the underlying cause of your bunion may actually be related not only to improper footwear but also going barefoot for too long — and proper footwear and foot dynamics may help.
Aleena Kanner, one of the leading postural experts in the U.S. and a certified Postural Restoration Institute (PRI) practitioner, created “The Shoe Ebook” to help you make informed footwear choices for pain-free — and bunion-free — feet.
Signs and Symptoms of Bunions
Bunions are among the most common chronic orthopedic conditions that affect the forefoot, with up to 28.4% of people affected.1 One of the most noticeable signs of a bunion is a bony bump that protrudes outward at the base of your big toe joint on the inner side of your foot. Your big toe may point toward your other toes instead of straight ahead, causing the big toe joint to become misaligned.
Bunions can cause pain or discomfort, especially when you’re walking, standing or wearing shoes that put pressure on the affected area. The bunion area may also appear swollen and red due to inflammation and irritation of the surrounding tissues. Some people with bunions may experience stiffness or limited range of motion in their big toe joint. However, in some cases there is no pain at all.
Bunions can also lead to the formation of calluses or corns on the affected foot, particularly where the bunion rubs against the inside of shoes. If left unaddressed, complications can also occur, including osteoarthritis and bursitis, a painful condition that affects the small, fluid-filled sacs called bursae, which cushion the bones, tendons and muscles near joints.
Bunions may also contribute to the development of hammertoe,2 an abnormal bending or flexing of the middle joint of one or more of the smaller toes. While anyone can develop a bunion, they’re more common in women and people with a history of foot injuries, such as athletes. There also appears to be a genetic connection, as more than 70% of those with bunions have a parent who also had them.3
While the underlying causes vary, the way you walk and your foot mechanics may play a role, likely in addition to other factors, like improper shoe choices, working on your feet for long periods or underlying inflammatory health conditions like rheumatoid arthritis or lupus.4 Uncovering the foundational cause of your bunion is key to proper treatment.
How Walking Barefoot Contributed to My Bunion
I visited Aleena Kanner, one of the leading postural experts in the U.S. and a certified Postural Restoration Institute (PRI) practitioner, to address a bunion I’d been trying to treat for a year. Although it wasn’t painful, I didn’t want it to get worse. After consulting with Kanner, I now believe one of the primary causes of the bunion was adopting a “barefoot” lifestyle for well over 10 years.
Going barefoot is great if you’re walking on the beach or grass — and is an important component of beneficial grounding — but I have tile floors in my home, and walking barefoot on hard, flat surfaces can lead to problems, including bunions, as there is no supportive structure for the foot. Kanner explains:5
“It’s been a huge [trend] lately, in the last, I’d say 10 years, to be wearing barefoot minimalist shoes, or no shoes. No shoes is fine if you are out in nature. I love grounding. We all know that there’s an exchange of frequency from the earth into our bodies, and that’s great if you are outside … in sand, in grass.
However, our society is not built like that. We are not walking outside in grass and sand all the time. We are walking on flat surfaces, and the problem with that is, our feet have arches, and we need to be able to give [them] the proper contact with the ground.
It ends up actually just slapping the ground and not creating that proper movement, range of motion in the foot, where we should have pronation, supination, pronation, supination. When we’re missing that range and that flow, it can lock up your neck. It can lock up your rib cage.
Wearing a specific shoe can open up that ability to have better range of motion at the feet, which can transfer up the chain. It’s a really hard topic for people because the minimalist shoes have a great marketing scheme. They’re saying our ancestors were barefoot. But you have to think about the context of that. They were not walking on pavement all day long in cities.
They were outside in nature, where the foot’s ability to pronate and supinate was still there because nature is uneven surfaces. So I want to get across, it is OK to be outside barefoot if you’re walking on an uneven surface on the beach.
But if you are in society and you’re walking in barefoot minimalist shoes or no shoes at all, and you’re having pain or symptoms … hormone issues, et cetera, a shoe with proper ability to ground, the sensory ability to ground, is going to most likely, almost always, make a positive change for that person’s well-being.”
How Proper Footwear Can Help
While surgery is sometimes recommended for bunion treatment, less invasive options, including choosing the proper footwear, can be effective for relief. Wearing properly fitting shoes with a wide toe box, for instance, can help relieve pressure on the bunion and reduce discomfort. Custom orthotic inserts or arch supports can also help redistribute pressure on your foot and promote proper alignment, reducing symptoms associated with bunions.
Acknowledging that “improper shoe wear can quickly defeat any physical therapy program,” PRI maintains a recommended shoe list that’s updated at least twice a year, noting, “Every time you stand up your whole body is influenced by your feet. No matter what is bothering you, if you aren’t getting better, perhaps you need someone to check your shoes.”6 Wearing the wrong shoes can certainly aggravate or ameliorate bunions, as well. Kanner says:7
“When I change the shoes on people, they can’t believe it because it’s such a simple thing you wouldn’t think about … If they’re in a minimal shoe, that is a big red flag for me as a practitioner.
It’s something I need to address to get their body to be able to relax and get into that calm state to combat whatever they’re dealing with … bunions specifically can happen on the right or left foot. They’re different and should be treated slightly differently from side to side.
This is something I think chiropractors, PTs, et cetera, movement professionals, don’t always know about the body, but we are asymmetrical, so we need to be treated as if we’re asymmetrical. We have a diaphragm on the right side that’s bigger and larger, and it attaches lower into the lumbar spine compared to the diaphragm on the left side.
We have three lobes of lung on the right and only two on the left. And we have a heart that sits on the left chest wall, which keeps that whole chest wall hyper-inflated. And we have a, on average, 3-pound liver on the right side of our body. Because of this internal asymmetry, we’re going to see slight changes in how that person feels and moves.
When I see a bunion, in general, I know that person is most likely lacking an arch of their foot. A bunion is when the toe is coming inwards towards the other toes. That person’s ability to feel the ground with their arch is going to be limited most likely, especially if it’s on the right foot.
When I give that person an arch where it should be, and if they’re not normally sensing that, we don’t necessarily see a huge decrease in the bunion. Maybe with time. It’s not an immediate change because it took time for that person to get a bunion in the first place. But we see major changes in that person’s brain’s ability to feel their feet on the ground.
Somebody with a bunion has really lost that ability to pronate, which is to flatten the arch into the ground and then use their right glute to push off and get the body weight to the left. When I see bunions, I know that there have been bony changes to adapt to somebody’s gait pattern or postural breathing pattern. Gait, posture and breathing are all tied together.”
A Personalized Approach Is Best
The shoes that are right for you are likely going to be different from your neighbor. Ideally, have a professional test you to make sure you’re wearing footwear that has the desired effect in your particular case. If that’s not possible, trial and error has few downsides.
Dr. Geoffrey Phillips, an orthopedic surgeon in Great Neck, New York, also revealed that properly balanced shoes can be fundamental to bunion treatment. TIME reported:8
“The main reason why people go to the doctor about their bunion is because they’re experiencing pain, Phillips says. Some can make lifestyle modifications that eliminate the need for surgery, especially if they start when their bunion is still in its early stages. Phillips’ first recommendation is to make footwear changes.
‘If they’re accustomed to wearing high heels, we try to change that reliance to more balanced shoewear,’ he says. ‘That can include shoes with a wide toe box, so there’s less pressure on the foot.’ It can also be helpful to seek out ‘rocker bottom shoes,’ which have a curved sole that smoothes out the transition from heel-strike to landing on the front of the foot.”
In my case, the bunion is on my left foot, and Kanner gave me arch support for my right foot. The reason for this is because bunions on the left suggests the right foot is not pronating properly. Added arch support allows the right foot to flatten and push off the ground properly, which in turn facilitates the proper movement of the left foot.
I also wear a spacer between the bunion and the second toe to keep them apart and to help the bunion from worsening. Another device that seems to be working quite well is a brace that has a steel bar on one side and a Velcro band that pushes the big toe out medially. There are many corrective devices out there, and working with a professional is best to determine which are useful for your unique case. Kanner adds:9
“When I say the shoe gives the brain the ability to sense the ground better, I’m talking about certain aspects of the shoe … A lot of shoes lack what we call a heel counter. A heel counter is the back of the shoe that grabs the heel and you can feel it. If it’s hard, it’s going to hold the heel in a better place, which is going to position the talus bone, which sits on top of the heel to align the body upwards in a better position.
Feel a barefoot shoe. There’s zero heel counter there. Then that person’s heel, calcaneus and talus, is going to go in whatever position the brain wants it to go in … That’s one component of the shoe. The other component of the shoe is the arch. When you think about walking on the beach, when you’re putting your foot in the sand, there’s sand that comes up to solidify [and] ground that part of your arch.
You don’t have that when you’re walking on flat surfaces. You’re just slapping your foot into the ground. The arch is getting no feedback. I see a lot of people enter a more parasympathetic state when you just put an arch in their shoe. So those are the things we look at with shoes.”
The general principle is that if you have a movement imbalance it will invariably tend to result in some type of injury over time. Further, your body is naturally asymmetrical. Balance is maintained through the integration of these system imbalances, and when balanced integration fails, structural weaknesses and pain, as well as bunions, can develop.
Before resorting to surgery, consider if a switch to better footwear can give you the relief you’re after. In summary, the essential components of proper footwear are:10
- A heel counter for calcaneal guidance, supporting the way the heel bone moves and aligns during walking
- Arch support for a better ability to pronate
- A flexible midfoot for fluid movement
- Proper heel lift
- A wide toe box for optimal alignment and comfort
For more information and guidance on selecting footwear, download “The Shoe Ebook.”
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