Bunions are not really caused by shoes.
Shoes aggravate a pre-existing condition. Bunions are nothing more than anatomic or genetic variation. God and your parents get all the blame. Barefoot populations and men get bunions.
Yes, a bunion is a knot on the inside of your foot. Exceptionally, it can be there from previous trauma. Most of the time it shows up gradually; sometimes in teens, more often in middle age. It occurs principally at the first metatarsal phalangeal joint; kind of where the toe bones, phalanges, connect to the longer foot bones, metatarsals…the MP joint or simply the MPJ.
Try this. Place your hand on a flat surface and close the thumb next to the index finger. On the inside your hand, you see a prominence at the MPJ, in the hand the metacarpal phalangeal joint.
By analogy, this prominence is what we see in the variant foot. In the hand, the first metacarpal diverges away from the rest of the hand bones. In the foot with a genetic bunion, the first metatarsal diverges away from the rest of the foot. The great toe is not opposable like the thumb, instead, it ends up nestling next to the second toe, rather limp and useless. When we walk on the foot the great toe gets pushed towards the second toe in propulsion or toe off. Over time the MPJ on the foot becomes more prominent.
If your foot rolls in more, as in over or hyper-pronation, the great toe easily pushes towards the second toe. Thus part of conservative treatment would include an orthotic to minimize this effect of excess pronation.
Generally, mild bunions are not operated on. When moderate and progressive they can be painful especially depending on the shoe and activity. Yoga may strain the bunion. Women have more bunion operations than men. While shoes do seem the be the reason here, the underlying genetic incidence of bunions is the same for women and men.
When conservative measures fail, surgical correction involves correcting the diverged metatarsal. The bump is shaved, and the metatarsal is cut to be moved closer to the second metatarsal eliminating the divergence in the horizontal plane. The metatarsal must also be “rolled” some to correct its position in all three planes. Fixation of the cut requires screw(s) and/or plate(s). One is often non-weight bearing for a month using a scooter and/or crutches, followed by a walking cast for an additional month. It generally takes up to three months to heal and some physical therapy may be indicated.
Each of us are uniquely stamped with a degree of anatomic variation we inherited from our parents. Often one leg and foot will not be the same as the other. From generation to generation, a bunion may present itself as mild, moderate or severe. For more information on living with or correcting bunions, call our office today for a consultation.