Bunions - overlooking the obvious

Bunions are a very common foot problem that is said to impact 30% of Americans and about 90% of those affected are women. Bunions can lead to significant pain and limitations in activity. What causes a bunion? 

Common thought is shoes. More specifically, shoes that have a tapered toe box that is too narrow to allow normal toe splay. Shoes can deform feet causing your feet and toes to conform to the shoe, as seen below:

Bunions are obvious on the feet above, but notice how the left foot is worse than the right? 

What caused the left foot to have a larger bunion than the right? 

The shoes look the same…except for a hole worn in the bottom of the left foot by the first metatarsal. 

Interesting. What would cause a hole to be worn in sole of the shoe? 

In a word: friction. 

Excessive friction will wear down one shoe faster than the other. To understand where the excessive friction is coming from and why, we must look at what the foot is doing during gait. Because the excessive friction is on the head of the first metatarsal we know the foot is abducted during gait and excessively pronating and everting during the push-off phase of gait. 

Abducted Feet

Overpronation and eversion of the right foot

Typically the foot is also pivoting on the first metatarsal from mid-stance to toe-off. This pivoting can also create large calluses and ingrown toenails at the points of friction. 

The faulty foot strike is usually caused by a lack of true hip flexion and extension and the compensation created by the dysfunctional hip joint. 

Hip flexion of right hip

Hip extension of right hip

Below is another very common example of a bunion being much larger on one foot than the other. 

Small left foot bunion and large right foot bunion

Shoes are not the reason for these imbalances. A faulty and imbalanced gait pattern is to blame, which is caused by postural imbalances up and down the body. Since the body works as a unit and everything is connected, we must look at a person's entire posture and treat all the major postural and muscular imbalances throughout their body.

Images from Pain Free for Women by Pete Egoscue

Balanced postural alignment allows the hip joints to flex and extend correctly leading to a normal foot strike allowing the feet and toes to maintain their normal position. Dysfunctional postural alignment interferes with normal shoulder, hip, knee, and ankle movement which is essential for every movement and activity. 

To feel how your posture affects your foot strike and causes bunions, do this simple test:

1. Take off your shoes and socks and walk up and down a hallway and feel how your feet are striking the ground. Where on the heel do you hit? Where does the weight go as you roll through your foot? Where do you push off from? Notice what is different between your right and left feet. Also notice if anything hurts. 
2. Now interlace your fingers together and put your hands behind your head so your elbows are out to the sides. Pull your elbows back as far as you can and hold them there. Relax your stomach. Now walk up and down the hallway again several times and notice your foot strike. What is different now? What changed? Why?

Most people feel their foot strike get more symmetrical left to right and balanced down the middle of their feet. This is letting your experience how much your shoulder and upper body position affects your foot strike. This also means that getting different shoes, orthotics, inserts, or foot surgery will not fix the problem. To fix the problem that is causing your bunions you much change your posture. Restoring your postural alignment and postural balance is the only way to treat the underlying cause of your bunions. 

If you'd like to know how to get started, contact me today for a free posture evaluation.