Are shoes really the cause of a bunion?

Whenever someone questions why bunions happen, many people are quick to blame shoe choices for the whole thing. While it’s true that poor shoe choices can contribute to the problem, are they directly responsible for bunions? Not necessarily. It may be more apt to consider them an accomplice to the crime instead of the mastermind. At Sunshein Podiatry, we want to make sure you have the right information to make informed choices about your foot health. Let’s investigate what directly causes bunions, and how shoe choices may play into that, if at all

Why Are Shoes Blamed for Bunions?

Let’s take a look at the evidence. High-heeled shoes, in particular, are the ones most frequently blamed for causing bunions, and they do certainly have some key points going against them.

• First of all, the very nature of high-heeled shoes shifts excess weight and pressure toward the front of the foot, which is where a bunion obviously develops (the scene of the crime).
• Then there’s the fact that many high-heeled shoe models have narrow, pointed tips that can compress and squash toes together, which certainly seems like it would coerce the big toe to shift inward.
• Finally, bunions are more common in women than men, and many of those women wear high-heeled shoes with at least some frequency.

So it doesn’t look good for tight, high-heeled shoes. But are they the core cause of a bunion? We need to delve a little deeper for more information.

So What Actually Sets a Bunion into Motion?

The center point of a bunion is the metatarsophalangeal (MTP) joint, at the base of the big toe. When this joint becomes unstable, the toe can start to progressively shift out of alignment. That is how the infamous “bony bump” forms and the big toe tends to crowd against its neighboring toes.

This instability occurs in a couple of different ways:

• Inheriting the instability—in other words, being born with it.
• Experiencing a trauma that destabilizes the joint.

Of these two causes, the first is most frequent. Bunions tend to run in the family, but that can be a very important clue for you and even your children! If your parents, grandparents, or other family members have bunions, your risk of developing MTP joint instability—which is often at the root of the problem—is higher. If you have that instability, your toe may have already started to shift, or it might not.

And that takes us back to shoes.

So Do Shoes Aid and Abide Bunion Development?

The question once again is: Can high heels and other forms of footwear be responsible for causing a bunion? And the truth is, there is still some debate on the matter. Spending tons of time in high-heeled shoes might apply enough stress to an otherwise healthy joint to destabilize it, but it's a common factor. What tends to be more likely is that the instability already existed in the first place, and the restrictive nature of high heels helped make the progression of the bunion worse by applying extra pressure.

Think of your toe like a fence post in the ground: If the ground is soft and not very stable (like an unstable MTP joint), it’s quite likely that the position of that post will shift as nature and time take their course. However, forcing your feet into high heels and/or shoes with tight, narrow toe boxes is like leaning against that post. That extra directional pressure and wiggling can easily lead to further instability and more progressive shifting.

So, while the jury may still be out for some experts on whether stressful shoes can directly cause a bunion, there is a clear consensus that long-time use of such footwear is bad for already existing bunions and joint instability.

Footwear and Treatment Recommendations From Sunshein Podiatry 

In the end, our advice about properly fitting shoes with you have a bunion is simple:

• If you already have a prominent bunion, don't wear high heels or shoes that compress your toes.
• If you believe you're in the early stages of a bunion, or if this foot deformity is common in your family, greatly limit your time in high heels and similar shoes.
• Actually, everyone should at least greatly limit their time spent in high heels and similar shoes!

Even if you never get a bunion, years spent in shoes that abnormally shift your distribution of weight across the feet can lead to other problems, including heel pain and hammer toes. There's no better time to reduce or eliminate your use of ill-fitting shoes for a bunion than now. However, if you're in the early stages of bunion development or have a higher risk for one, this can be an especially pivotal time for you.

While much can be done, both non-surgically and surgically, to help patients who have had prominent bunions for years, an even more beneficial course of action is to catch a bunion in its earliest stages and take steps to slow or stop its progression altogether. Our Centerville foot doctors believe that conservative treatments such as conditioning exercises and custom orthotics can go a long way toward strengthening your MTP joint and shifting excess weight away from the instability. They provide a big advantage in saving you a great deal of trouble and discomfort in the future.