A bunion, medically known as hallux valgus, is a bone spur that forms at the joint at the base of the big toe. This occurs when some of the bones in the front of the foot move out of place, pulling the tip of the big toe toward the little toe and causing the joint at the base of the big toe to pop out.
Known as the metatarsophalangeal (MTP) joint, this joint may become swollen and painful. About 19% of adults worldwide have bunions, with women and people over 60 more commonly affected.One Although the cause of bunions is not always known, the shoes you choose can significantly contribute to their development and worsening. Plus, good shoes can help prevent and treat it.
Aleena Kanner, one of America's leading posture experts and Certified Posture Restoration Institute (PRI) specialist, created a “shoe e-book” to help you make informed shoe choices for pain-free, bunion-free feet.
How can inappropriate shoes affect bunions?
Wearing shoes that don't fit well or that aren't designed for foot health can take a toll on your feet. Kanner points out:2
“Our feet are amazingly designed, made up of 28 bones that can move in a variety of directions. In addition to facilitating movement, our feet play an important role in communicating with the ground and transmitting important sensory information to the brain. It's fascinating how they interact with the land, delivering important feedback with each step we take.
From the moment we wake up, our feet are our first point of contact with the ground. Therefore, the shoes we choose have a huge impact on our overall body health and alignment.”
For example, wearing shoes that are too tight or narrow can cause the toes to press together, putting the big toe in an unnatural position.three This pressure can cause the bones in the foot to become misaligned, potentially leading to the formation of a bunion at the base of the big toe. The same goes for shoes with pointed toes, which place the toes in an unnatural position and increase pressure and friction on the MTP joint.
High heels are also a problem,4 As your weight shifts forward, excessive pressure is placed on the front of your foot, including your toes. Not only does this force your toes into a tight space, but it also increases stress on the MTP joint.
Wearing poorly fitting shoes that are too small, too big, or lack adequate support can also cause bunions. Small shoes can squeeze your toes, while large shoes can cause your foot to slide forward, putting undue pressure on the MTP joint.
Most bunions are caused by 'years of abnormal movement'
Bunions are often thought to have a genetic link, as more than 70% of people with bunions have a parent who has them.5 However, most bunions are not caused by genetic factors alone but are related to abnormal or incorrect movement patterns. Kanner explains:6
“Bunions are often due to genetic factors alone, but poor movement patterns also play a role. Now, I'm not suggesting that your mothers and grandmothers are exempt from the bunion club. But we shouldn't put all the blame on them! Observing the movement patterns of older people can influence our own, potentially leading to similar patterns.
If your foot lacks the support and alignment it needs, it can put abnormal pressure and stress on the joint at the base of the big toe, which can eventually lead to the formation of a bunion. Although this may contribute to the development of bunions, labeling them as genetic may stem from limited understanding rather than conclusive evidence.
Bunions are caused by Wolff's law, which suggests that bones adapt to mechanical loading. “This makes it more plausible that movement patterns rather than genetics contribute to development.”
The American Podiatric Medical Association says bunions are often the result of years of abnormal movement.7
“Bunions form when the normal balance of forces on the joints and tendons of the foot is disrupted. This collapse can cause joint instability and deformity. Bunions are caused by years of abnormal movement and pressure on the MTP joint. Therefore, this is a symptom of poor foot development and is usually caused by the way you walk, your inherited foot type, or your shoes.
Bunions tend to run in families, but the foot type, not the bunions, is inherited. Parents who suffer from foot mechanical deficiencies may pass the problematic foot type on to their children, making them prone to developing bunions as a result. “The abnormal function that results from this poor foot development can put pressure on and within the foot, often resulting in bone and joint deformities such as bunions and hammer toes.”
Lack of arch support may contribute to bunion development
Adequate arch support is important for proper foot mechanics and is a key factor in why PRI works with Hruska Clinic to evaluate the list of recommended shoes. This list is updated at least twice a year. Arch support helps with proper pronation, which moves the foot naturally by rolling inward to dissipate the force of impact while walking or running.
In normal pronation, the foot rolls inward about 15%, allowing the arch to absorb shock and support body weight.8 This movement helps your feet adapt to different surfaces and provides a stable base for your body. However, Kanner says, “Lack of adequate arch support and insufficient foot pronation can contribute to the development of bunions.”9 She explains:10
“Adequate arch support is important to promote proper foot pronation and support neurological function. Foot pronation, the ability of the foot to lie flat on the ground and help the body move forward, is essential for healthy movement. Lack of adduction can manifest itself in a variety of ways during a gait evaluation.
We can observe people turning their feet outward as they try to find a way to push off their standing leg. You may also notice the development of bunions, which are associated with an inability to effectively pronate. Without proper arch support, the natural movement patterns of the foot can be disrupted, which can lead to discomfort and alignment issues over time.”
Your barefoot lifestyle has likely caused you to develop bunions.
Ill-fitting shoes or shoes that lack support can cause bunions, which can lead to not wearing any shoes at all, especially if worn for long periods of time. I went to Kanner to address a bunion problem I had been trying to treat for a year. After consulting with her, I believe the main cause of her condition was her barefoot lifestyle for over 10 years.
When walking on the beach or grass, walking barefoot is a good and important component of beneficial grounding. However, if your home has tile floors, walking barefoot on a hard, flat surface can cause problems, as can unsupportive shoes. , because there is no structure to support the foot. Kanner explains:11
“In the last 10 years or so, there's been a big (trend) to be barefoot and wear minimal shoes or no shoes. If you're out in nature, any shoe will do. I like grounding. We all know that. From the Earth to our bodies. The fact that the frequencies are swapped, and if you're outside in the sand or grass, that's great.
But our society is not structured that way. We don't always walk on grass and sand. We are walking on a flat surface, the problem is that our feet need to have an arch to provide adequate contact with the ground.
It's really just pounding the ground and results in not producing the proper range of motion in the foot, which is where it should be: adduction, abduction, adduction, and supination. If we lose sight of the scope and flow, we can get stuck. You can lock your ribcage.
Wearing certain shoes can allow your feet to have a better range of motion and transfer up the chain. Minimalist shoes are a really difficult topic for people because they have a great marketing strategy. They say our ancestors were barefoot. But you have to think about the context. They didn't walk the pavement all day in the city.
They were outside in nature, and since nature is a bumpy surface, the ability to pronate and abduct the foot was still present. So, if you want to cross, but you're walking on the uneven surface of the beach, it's okay to be barefoot outside.
However, in society, if you walk barefoot in minimal shoes or wear no shoes at all and experience pain or symptoms… hormonal problems, etc. Shoes with adequate traction, shoes with reduced sensory abilities are almost always positive for the person's well-being. “It is likely to bring about real change.”
Proper shoes can help prevent and treat bunions
Surgery, painkillers, and cortisone injections are common treatments for bunions. However, there are safer, less invasive options for relief, including choosing appropriate footwear. “If I changed people’s shoes, they wouldn’t believe it,” Kanner said. Because it’s such a simple thing that you wouldn’t even think about,” says Kanner. She points out:12
“Typically, when you see a bunion, you know that the person most likely has a poor arch in the foot. A bunion is when a toe turns inward toward the other toe. A person's ability to feel the ground through their arch is likely to be limited, especially if they are on their right foot.
When I give that person an arch where they should have an arch, if they don't detect it normally, we don't necessarily see a big reduction in bunions. Perhaps in time. It is not an immediate change because it took time for the person to get the bunion in the first place. But we see significant changes in a person's brain's ability to feel their feet hitting the ground.
People with bunions have actually lost the ability to pronate, which involves flattening the arch to the ground and then using the right glute to push off and shift the weight to the left. Bunions indicate changes in the bone to adapt to someone's walking or breathing posture patterns. Gait, posture and breathing are all tied together.”
According to Kanner, the essential components of proper footwear are:13
- Heel counter for calcaneal guidance to support the way the heel bone moves and aligns while walking
- Arch support for better pronation ability
- Flexible midfoot for flexible movement
- Correct heel lift
- Wide toe box for optimal alignment and comfort
For examples of shoes that meet these requirements, see PRI's list of recommended shoes. However, the right shoes for you may be different from your neighbor's, so a personalized approach is best.
Ideally, get professionally tested to ensure you are wearing shoes that support proper foot biomechanics and have the necessary effectiveness to meet your individual needs. For more information, read Kanner's “The Shoe Ebook” to help you make informed shoe choices.
