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September 22/23 TORONTO
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Have you got a Bunion-in-the-Oven?
Most people who sport a bunion have no idea how it got there. They do know they didn’t just wake up one day to discover a bunion has sprouted from their foot overnight. It takes a while to get one (or two) and this process is called adaptation.
An adaptation is a change that occurs over time as a response to a biological signal. In this case, it is the signal to create more robustness in a site that is under stress. The Bunion is the correct response to a biological signal to add robustness to a site that is under continual stress/overload. Bunions can occur at the first (big toe) metatarsal joint and also the fifth (baby) toe metatarsal head (often referred to as a “bunionette” – which sounds a lot cuter than it is).
Hallux valgus (or hallux abductovalgus) is the anatomical term for the deformity which displaces the bones of the big toe and the first ray, or metatarsal. The associated soft tissues (tendons, ligaments and muscles) of this joint are displaced and experience loads that are unnatural both in intensity and in plane, or position. It is the transverse (sideways) plane motion that is associated most strongly with this eventual bone dislocation but there is a rotational element as well to both the bones of the toe and the metatarsal.
The mechanics of feet are important to get right and walking a certain way, or changing the optimal mechanics of a natural (bare) foot, is going to create changes to the loads to your foot, which your body will deal with by possibly increasing bone density or shape in response to an unnatural load to tissues that would otherwise fail. The softer tissues of the muscles and ligaments will become misaligned and can cause inappropriate wear and tear on structures of the foot, creating pain!
Most of what we do to treat bunions is treating the symptom, which alleviates much of the discomfort. But like anything that doesn’t get at the root cause, it is just a band-aid solution, but one you should take because improving the comfort of your feet is just too important for the health of the rest of your body to ignore (i.e., you won’t want to go move the rest of the body if the feet are hurting and if you are sedentary your other systems will suffer). Once you get moving again, you can start the corrective work necessary to move yourself out of orthotics.
Now I know what you are thinking. You have probably been told that bunions are genetic. Genetics are misunderstood as a kind of code written into your DNA that is inevitable – meaning you can’t do anything about it and you are simply doomed to the outcome. It seems reasonable to assume that bunions are genetic because you might have very similarly shaped feet to one of your parents. But the truth is you inherit some things from your parents: the size, girth and shape of the bones is one thing. However, bone is living tissue. It can morph and change depending on the loads it is subject to most frequently. You may have inherited the shape of the pelvis, hips, legs and feet bones (and subsequent joints) from your parents, but it’s how you use them that determines their final shape and function. Another thing that has perhaps a greater influence on the shaping of your bones is the movement “accent” that you learn from your parents. Just as we pick up speech patterns as we learn to talk, we pick up movement cues from watching those around us as we develop our motor skills. It is these movement “accents” that we mimic and which become our habitual way of walking that eventually creates the bunion. So it’s important that we look at the mechanics of how we walk and their contribution to our shape, more so than the genetically inherited shape of our bones. Bunions are not something written into the DNA code that will simply manifest one day without cause – they are mechanically stimulated. If bunions were genetic, you’d think they would occur on both sides to the same extent, but that is rarely the case. Many people have only one (and that’s a big clue to how you are using your body asymmetrically) and others have a bigger one on one foot than the other.
Shaped by our environment
There are other reasons we walk the way we do, that are not genetic or learned. We can be literally shaped by our environment. Shoes, chairs, our urban habit of making everything flat and level…all leave us with adaptations in the length of our muscles and shape of our bones, which in turn affects the way we stand and walk.
So you might be “cooking” a bunion right now! You have the potential to develop a bunion if you are creating the environment that causes it. It’s a whole different way of looking at something you are used to thinking of negatively. Your body is actually responding appropriately! It’s not a positive adaptation, but it’s a correct one. What an amazing thing our bodies are, yet we continually denounce them for betraying us and creating this dumb and ugly lump on the side of the foot. This lump that rubs against my (too small, too narrow) shoe and causes me pain with every step.
So what can you do? What can you do to halt this bunion from forming, forming further, and/or reduce the pain associated with bunions? The loads that are creating the adaptation can be changed! With this change, your foot health can be improved, pain alleviated and the further formation may be halted. If you don’t have a bunion, these tips will still help you achieve the healthiest feet possible.
Free the Feet
I mentioned earlier that a change in the optimal mechanics of the bare foot is bound (pun intended) to result in a change to the loads of the structures of the foot. It is simply impossible to have optimal gait mechanics in shoes – especially if the shoes have a positive heel and constricting toe box (most all modern shoes). It is constriction of the toes that is strongly associated with the mal-positioned bones and creation of the bunion. Making a better choice in footwear is your first step in improving the health and function of your feet. Moving towards a minimal shoe, with a flexible sole, wide toe box and no positive heel is a must. Depending on your current footwear choice, this transition must be done carefully and mindfully and slowly.
Restore the Feet
You may need to do some restorative work to prepare your feet for freedom. It is important not to make big changes too quickly. Remember that word “adaptation”? Just as it may have taken decades to create the adaptation that eventually resulted in your bunion, it will take time for the tissues of your foot and lower leg to adapt to a change in your footwear. Even a change from a 2” heel to a 1” heel is a big change (and a good one) to your body. Structures that have adapted to joint positions associated with shoes need to be treated kindly. Massage, self massage, myofascial modalities, and Restorative Exercise corrective exercises can help prepare those tissues so that injuries do not result.
An example of one of the muscles you can restore is the Abductor Hallucis which pulls the big toe out away from the other toes. This muscle’s function is usually lost when you have formed a bunion. Even more complex, is that the function of this muscle can change from one that pulls the big toe away from the second toe (intended) to one that contributes to the big toe moving over the second toe (adapted). You can learn how to get this muscle back in line, and then back online.
Align the Feet
Stop walking with your feet turned out like a duck. Ducks don’t actually walk this way – ducks have been unfairly maligned. But you know what I mean: that turned out position where the toes are wider than the heels. When you walk this way, you change the mechanics of the foot’s engagement with the ground and introduce a rotational element. It is this rotation from the outside of heel to the big toe knuckle (metatarsal head) that drives the load over this joint and displaces the big toe (hallux) towards the second toe. You will notice that the big toe is not just pushed over, it’s twisted or rotated.
When walking straight ahead, the feet should face straight ahead. Of course, varying the terrain and your movements can elicit many more healthy angles from the foot and ankle as required and desired.
Wear toe spacers to get the big toe over to where it should be and to help spread the toes. This might sound like that band-aid solution but if you are walking around with a bunion, just fixing the alignment of your feet won’t change the loads as now the bunion itself becomes a force that creates a specific gait pattern. I’ve noticed that I can change the shape of my feet when I’m standing still, but when I walk I have a lot less control over what my feet are doing. Using something that will keep the big toe aligned will help. I like Correct Toes because they can be worn all the time, both in shoes (toe box permitting) and barefoot.
I also wear My Happy Feet socks around the house or at night in bed. These products help spread the toes back out to where they should be – the widest part of the foot. Both of these products are designed to be worn while moving, which is ideal.
Video – “Fix Your Feet”
Excellent video from Podiatrist Dr. Ray McClanahan, founder Correct Toes (and check out his other videos on bunions on YouTube!):
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