HEAD OVER HEELS Bunions are not genetic, but purely down to footwear choice in childhood and adulthood.
I’m sure the German language has an extraordinarily long word that translates as ‘an unpleasant name for an unpleasant condition’. In English, we have the perfect example: bunion. I’ve never met anyone who likes the sound or the look of one.
Everyone knows what bunions are, but it’s worth describing them briefly. Medically known as Hallux Valgus (which makes it sound so much nicer!), a bunion is where your big toe bends sideways towards the second toe and a bony lump forms at the base of the big toe. In severe cases, the big toe can end up underneath or on top of the second toe and the bump becomes painful.
Research suggests that almost a quarter of adults younger than 65 have bunions, while 35 percent of over 65s are affected. Perhaps not surprisingly, bunions are more common among women, with studies showing women are nine times more likely to present with bunions.
Bunions develop when the big toe is pushed across towards the second toe and held in place for long periods, typically when squashed into narrow shoes. Whilst they are more common amongst older women, this is a slow developing condition that has its roots in childhood.
The bones of the foot don’t harden until the late teens, meaning that ill-fitting shoes in childhood will reshape the bones of the foot. I have said it in these pages before, if you look at a toddler’s foot, it is almost triangular in shape, with the widest point at the toes. Now look at kids’ shoes and you will see they are more oval shaped and narrow at the toes.
Forcing the big toe across like that significantly affects the mechanics of the foot, making it weaker and less stable. The metatarsal bone of the big toe has four times the density of the other metatarsals because bodyweight is supposed to be transmitted along that line during the gait cycle. If that isn’t possible due to poor alignment, the foot becomes less stable, affecting balance. It is no surprise that falls are more common in older populations where bunions are also more prevalent.
Why is it that women are more likely to develop bunions? Put simply, they are more likely to wear ill-fitting shoes: think high heels and narrow toes, and remember that a large percentage of women buy their shoes a size too small!
I’ve lost count of the number of times I have heard that bunions are genetic, and ‘I have them because my mum and my granny have them’. But for a variation from the norm to be so prevalent due to genetics it would need to be due to natural selection, in other words it should help the survival of the species, either by making us stronger or increasing reproductive rates. Bunions, as mentioned earlier, neither make us stronger nor more attractive, which rules out the genetic component. Unfortunately to those people my answer is always ‘No, you learned your shoe preferences from your mum and your granny!’
What to do if you have bunions? For those of you who have developed a bump at the base of your big toe but not pain, the first thing to do is take off the tight shoes. The more space your forefoot has in the shoe, the less your toes get compressed.
Secondly, take off (or at least reduce) the heels. When you stand in high heels, your foot is wedged forward into the toe-box of the shoe, squashing the toes even further. Now, I understand that there’s been scarcely an excuse to wear heels in the last year, and that you love them and they look good, so don’t throw them all in the bin – but maybe don’t wear them every day to the office if you ever get back there.
If you have bunions that have become painful and have already limited your footwear choices, there are options. Mobilisation of the toes and foot can help to relieve the stiffness and pressure that develops in the foot, and there are exercises to do to reactivate weak muscles and loosen stiff joints. For some people, orthotic insoles may be helpful. Surgery is an option that can be very successful, if initially painful; removing the bony lump and straightening the big toe.
Perhaps most importantly, if you have children, ensure their shoes are as wide, flat and unstructured as possible so that they don’t end up blaming their mums and grannies for their foot problems!
Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.