When a patient has a bunion, the big toe angles in towards the other toes, a condition called hallux valgus. Bunions are most common in women, and the cause is almost always due to unsuitable footwear. The word 'bunion' is derived from the Latin word bunio, which means turnip.
What causes a bunion?
Tight fitting shoes are thought to be the cause of bunions in about 90% of patients. Shoes such as high heels are particularly damaging to the toes. These shoes have a sloping foot piece and a narrow toe box. The slope causes the front of the foot to be pushed with force into the narrow toe box. The narrow toe box causes the toes to become squeezed together. Depending on factors such as duration of wearing constraining footwear, skeletal maturity, and individual factors, the toes can become permanently adapted to the new position and lead to the formation of a bunion.
Don't believe me? Consider the following:
- The average woman in the U.S. wears a dress shoe that is 2 1/2 sizes too small.
- Bunions occur in about 3% of the population in countries where people wear non-Western style shoes. They occur in about 33% of the population in Western countries.
- Step 1: Get your nicest dress shoes
- Step 2: Set your shoe on the floor and stand next to it
- Step 3: Decide which is bigger--odds are the shoe is smaller than the foot.
- If the picture above looks at all like your feet and shoes, you may have found the source of your problem.
Once a bunion has formed, the mechanics of the feet and toes are altered. Tendons begin to pull the toe into an abnormal position, and the problem tends to progress over time.
Patients who develop bunions often seem to have a genetic tendency to do so. As stated earlier, even in countries without Western-style shoes, about 3% of the population will develop a bunion. Therefore, it's not only the footwear that's the problem--it's just that it's mostly footwear that is the issue.
If you still refuse to believe that footwear is causing your bunions ("I hardly ever wear shoes like that!"), then you fall into one of two categories:
- Denial, or
- You're one of those 3% that can blame your parents (genetics).
Patients with bunions generally have one of two problems that can cause pain:
- Pain over the bunion
As the big toe becomes more and more angulated (pointing towards the other toes), the base of the toe becomes more and more prominent, thus forming the bunion. The bunion forms in part because of the new angulation of the toe, and in part due to inflammatory changes over the bunion surface. As the inflammation worsens, people can experience pain with shoe wear and walking. - Development of a hammer toe
The big toe may eventually come to lie over, or more commonly under, the second toe. This may cause further irritation while wearing shoes, and cause more pain. The second toe of patients who have bunions commonly forms a hammer toe.
