When I think of bunions, I think back to my childhood and can still imagine seeing old women with shoes cut off on the big toe and very wide feet. Where the shoe was cut, there was a bump on the side of the foot sticking out. During my first years of practice, older patients came with similar shoe modifications. Luckily now I don't see this anymore as there are shoes available that avoid the need to open them to handle bunions on the feet. This blog will explain bunions and the best shoes and sandals for onions.
What is an onion?
So what is an onion? A bunion a bump on the big toe side of the foot (medial side) just below the big toe. This bump is actually a bone, the head of a foot bone called the first metatarsal. There may be an inflamed soft tissue sac of fluid called a bursa on the bone, but the bump is bony. Usually this bump goes hand in hand with a wide flared foot so that it sticks out even more. The first metatarsal bone just behind the big toe pulls away from the rest of the metatarsals and the head of the bone protrudes.
In most cases, the bunion is part of a more complex deformity called hallux abducto valgus or hallux valgus. Hallux is the medical term for the big toe. Abducto or abduction is the term for the big toe deviating towards the little toe of the foot (lateral side). It can be severe enough that the big toe encroaches on the second toe, sometimes going under the second toe and sometimes over the second toe. This can create a secondary foot condition, hammertoe second toe, which is a deformity of the toe where it twists and lifts in the middle and the end of the toe drops down. Finally, valgus means a big toe rotation where the bottom of the toe rotates upward to end up on the side facing the second toe.
What causes a bunion?
How does this significant deformation occur? There are several reasons for the formation of a bunion.
- • Genetics: in many cases, it is a genetic tendency passed down from generation to generation more frequently in women. The underlying causes are still being investigated, but in general the theory is that there are biomechanical defects in the foot that impair foot function, leading to overpronation and resultant abnormal stresses when walking or walking. the standing position. Over time, this damages and stretches the ligaments that hold the bones together, allowing for increased movement of the foot and resulting displacement of the bones, causing the deformity.
- • Sex: The women generally have more flexible ligaments to enable them to give birth and are more prone to this phenomenon. Ligaments stretch more during pregnancy, which increases sagging.
- • Ill-fitting shoes: To add insult to injury, many women's shoes contribute greatly to deformity as they often press the toes together due to the narrow, narrow toes that are often found on many shoes "to the fashion ". This constant compression is like braces on the teeth that move the teeth by constant pressure. Many women's shoes work the same way, forcing the big toe towards the second toe. High heels add even more strength to the forefoot, which exacerbates the deforming force of the shoe's narrow toe box. Although shoes by themselves probably don't cause bunions, they do speed up the formation and add to the deviation of the bones, causing more serious bunions.
Tailor's onion
Before we go any further on the bunions, there is another deformity that is often linked and can be found in conjunction with hallux abducto valgus. This deformity has many different names, including tailor's bunion, bunion on the little toe, and toe. The term tailor's bunion is due to tailors sitting cross-legged to sew in ancient times, causing a bump on the little toe of the foot. In effect, this deformity is a mirror image of the bunion on the big toe. On the little toe side of the foot is the fifth metatarsal bone which sits behind the little toe. With a tailor's bunion, the fifth metatarsal moves away from the foot so that its head sticks out forming a bump called a bunion. Similar to hallux valgus where the big toe deviates towards the second toe, in a tailor's s bunion the fifth toe moves to the fourth toe. In many cases, there are bunions on both sides of the foot because the same forces that cause bunions also cause tailor's bunions. The result is a very wide splayed foot with the big toe and little toe deviating towards the middle of the foot. This type of foot has major problems fitting shoes.
Bunion symptoms
Bunions can hurt for several reasons.
- • Pressure and irritation: pressure exerted on the bump itself by shoes, as most shoes don't leave enough room for the protruding bump(s) on both sides of the foot. In these cases, the bunion bump becomes irritated from the friction of the shoe and can be inflamed and painful. This is the most common symptom.
- • Joint of the big toe: The abnormal position of the big toe damages the joint and its cartilage, causing locking of the joint, arthritis and pain.
- • Training of hammer toe : Sometimes a bunion can create a hammertoe on the second toe due to the big toe impacting it. This hammer toe can cause pain from the friction of the shoe on top as it sticks into the shoe, and its joint to the foot damaged and inflamed by the deformity.
- • Alteration of the gait: the bunions can alter a person's gait due to the abnormal shape of the forefoot which throws them off balance, reducing their ability to function normally. This change in gait can cause foot, knee, hip and back pain.
How to treat onions
So how to treat onions or relieve the pain of onions ? The many techniques available to correct a bunion and tailor's bunion are beyond the scope of this blog, but the basic principle is to relieve pain. When it comes to bunions and tailor's bunions, the only real treatment is surgery to fix the deformity. Each surgeon assesses the individual patient to decide which procedure to recommend. If you are considering bunion surgery, ask for a full explanation of the planned surgical plan. Bunionectomies are performed fairly frequently by podiatrists and by foot and ankle orthopedists.
- • Osteotomy: surgery to cut the metatarsal bone and change its position while moving the big toe and/or little toe into its anatomical position. Usually this requires pins or screws to hold the bone in place while it heals.
- • Bumpectomy: a procedure that only removes the bunion or bump from the side of the foot but does not correct the position of the joint or the big toe or the same from the side of the little toe. A bumpectomy is a simple but only partially effective "cure" because the deformity still exists but at least it is easier to put on shoes.
- • Minimally invasive bunion surgery: some surgeons have chosen to practice it. It is a surgical procedure performed through a small hole or several holes rather than an open incision. For some patients this can be done, but is not always the case at this stage due to the need for extensive correction of multiple anatomical parts during many bunionectomies.
Bunion Shoes
The title of this blog is "Best shoes for bunions". To begin with, many patients prefer to avoid surgery for several reasons. So the question is, how can I, as a podiatrist, relieve bunion pain without surgery? It all starts with the SHOES. The best bunion shoes and sandals will have the following features:
- • Lenght : I recommend orthopedic shoes and sometimes extra-wide shoes to accommodate the wide, flared foot that develops with bunions and tailor's bunions. The wide width will not constrict the foot and create a pressure-free environment for the bunion. Unfortunately, most shoe brands only offer medium widths, which can make the situation worse. Your best bet is to look at orthopedic brands such as Comfort-Orthopaedic who specialize in wide width shoes with options up to 6E!
- • Toe area: The other key feature is not just the width but the shape of the toe box at the front of the shoe. The toe area that houses the bunion should be round and not pointy. I've seen many shoes labeled wide but have narrow toe shapes that defeat the purpose of wide width. Additionally, the toe box needs to be high to accommodate the hammer toe often linked to the second toe sticking out upwards. In addition, the big toe can also stick with a bunion and therefore the shoe needs more height in the toe area. Comfort-Orthopaedic shoes are specially designed for this purpose with round, roomy toes that are also high. I wear them myself, as does my wife, as we both have very wide forefeet that need the space Comfort-Orthopaedic provides .
- • Sole orthopedic : them Orthopedic shoe manufacturers design shoes with built-in orthopedic insoles that help stabilize the deformed foot, especially with overpronation. A brace can slow the continued worsening of the deformity and reduce pain by redistributing forces to damaged joints in the forefoot.
- • Additional depth: a deep shoe construction along the entire shoe is also a big feature that is required for bunion housing. An extra depth shoe generally has more overall space and the ability to handle an insert. Comfort-Orthopedic shoes are extra deep to allow adaptation of the deformity and a personalized insole.
- • Soft and seamless interiors: With a soft, seamless foam-padded inner liner and flexible outer material or non-overlay uppers, provide gentle bunion contact and help relieve bunion pain.
- • Upper in stretch fabric: when shoes are constructed with soft, stretchy materials, they follow the contours of the foot, hence the bunion bump, and exert no pressure on it. Comfort-Orthopaedic offers many stretchy shoes and sandals that work exceptionally well for bunions.
- • Heel-to-toe drop: the best shoes should be low to the ground with low heels because any heel height is counterproductive for a forefoot with bunions and/or tailor's bunions. If the heel is elevated even slightly, additional force is exerted on the forefoot, pinching it forward, causing stress on already damaged joints, further destroying cartilage and adding to the deformity, accelerating the process. deformity and causing more pain.
- • Heel counter: the shoes should also have a firm heel counter and a firm outsole for stability. Pronation, which is excessive movement of the foot, causes bunions to form and progress. Thus, the shoe must be stable to reduce the pronation movement.
Other bunion treatment
There are many "onion lifters" on the market for sale. Some of them are gimmicks while others can relieve pain. However, an onion cannot be "corrected" by any of them.
- • Simple bunion pads on the bump can help relieve some of the irritation caused by rubbing shoes and protect them from further injury.
- • Some socks have built-in “bunion shields” that can also help protect the shoe's bunion. other socks, are designed with split toe technology which includes a seam between the first and second toe to help separate it from other toes. It also reduces chafing and irritation.
How to prevent bunions
Is there a way to prevent bunions? Yes and no.
Yes, you can slow the progression and severity of the deformity, but not in most cases, if the tendency is for bunions, it will still happen. To slow down the progression and the amount of strain, it always comes down to the shoes. Poorly made or ill-fitting shoes with high heels and narrow toes will speed up the process and make the deformity worse. Once the position of the joint changes from those bad shoes, it is PERMANENT. So, I warn all my patients that the best thing they can do for their feet is to switch to more appropriate shoes early in life. If they have a lot of pronation or have hypermobility, orthopedic insoles are necessary.
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