Bunions: Inherited Faulty Foot Structure

We hear this a lot from our patients:

“Why do I have a bunion, Dr. Danciger?”

That’s probably a common question for a lot of other podiatrists out there as well. And it makes sense. After all, if you don’t have a medical background, it can be confusing to look down and figure out why there’s a bump protruding out from the inner edge of your foot.

Some patients will guess that it relates to the shoes they wear. That is a sensible assumption—especially for women who frequently wear high-heeled shoes with narrow toe boxes.

Well, in just a moment we’ll look at the matter of whether shoes cause bunions or not, but let’s start with helping you to recognize this condition.

How do you know if you have a bunion?

As we mentioned, a bunion includes a bump that juts out of the inside part of the foot. More specifically, you will find this at the base of the big toe.

That joint—where the toe connects to the foot—is known as the metatarsophalangeal (MTP) joint and plays an instrumental role with this condition.

In fact, a bunion develops when the MTP joint is forced out of position for reasons we’ll explain shortly.

Another symptom of bunions related to the joint displacement is that the big toe will start to angle inward. When the toe deformity becomes severe, the wayward toe may eventually overlap its neighboring toe(s).

It’s worth noting that the bulge on the inner edge of your foot may have a reddened appearance. If so, this is because shoes are generally designed to accommodate feet without bunions. As such, a bunion can rub against the inside of a shoe and become irritated.

Along with irritation, skin might develop corns, blisters, or calluses from the friction caused by normal, narrower footwear.

Since we’re talking about footwear, it’s a good time to address a very common question:

Do shoes really cause bunions?

For many years now, people have been quick to blame footwear—especially high heels—for bunion development.

From a logical perspective, it’s certainly understandable:

A high-heeled shoe will place greater amounts of force on the front of the foot (including the area where you find the MTP joint). On top of that, pumps and stilettos often feature pointy, narrow toe boxes.

If you’ll recall, the big toe will typically angle inward—and some people attribute this to the way those pointy fronts can squish the toes.

While this is all reasonably logical, it ignores the bigger issue at play:

Instability in the MTP joint.

And that is more likely to be caused by an inherited foot structure.

So high heels don’t play any role in bunions?

Not quite. Sure, they might not be entirely responsible for these toe deformities, but they can exasperate an underlying condition.

That means choosing fashion over comfort can play a role in helping a bunion start to emerge or making an existing bunion worse.

Can anyone get a bunion?

While bunions tend to be more common in women and seniors, the fact of the matter is that virtually anyone can develop a bunion over time.

Now, bunions are extremely rare for children, but this does happen sometimes. This can be attributed to that root cause—instability in the great toe’s MTP joint.

Still on the rarer side—but not quite as rare as for children—are cases of men developing bunions. And since this does happen, it lends credence to the notion that bunions are not necessarily caused by high heels.

Basically, if the genetically inherited conditions are favorable for bunion development, virtually anyone could possibly end up with a bunion (or two).

What kinds of inherited foot structures have greater bunion risk?

From a general, overall perspective, foot structures more likely to contribute to bunion formation and development are ones wherein feet are unable to absorb or disperse the impact forces from walking, running, jumping, and perhaps even simply standing.

The degree to which feet can handle the force loads will depend on an array of factors. A primary one, however, is the foot arch.

Our arches are unsung heroes of the lower limbs. They contribute to shock absorption while also propelling our feet forward during the ground portion whenever we take a step.

To most efficiently absorb and distribute force loads, arch height and shape must be within in a normal range.

When the arches are low (“flat foot”), too much of the force ends up going to the inner, front of the foot—right where the MTP joint is located. This happens because low arches can cause overpronation, which means the foot rotates excessively.

Conversely, arches that are too high can also be problematic.

In the case of overly high arches, the feet don’t rotate enough. This leads to extra force on the outer edge of the foot. If this is not corrected with proper footwear or a pair of orthotics, it can cause a mini-bunion—a bunionette—to form at the little toe’s MTP joint.

Bunionettes are quite like their larger, more common cousin on the inside of the foot. They’re just found on the other side and affect the small toe.

How are bunions treated?

At the end of the day, here’s the deal:

More important than knowing why you have a bunion is understanding what can be done about one.

And treating a bunion is essential.

This condition can be categorized as progressive. If you are unfamiliar with the term and don’t know what it means in this context, there are two key elements. Progressive conditions:

  1. Will continue to worsen over time (when left unaddressed). The human body has amazing healing properties for a variety of health issues. Progressive ones do not fall in that camp. They don’t get better on their own and increase in severity over time, unless action is taken.
  2. Can only be truly corrected with surgery. Now, this doesn’t mean there are no nonsurgical treatments for bunions. Rather, it means that the only way to restore the wayward joint to its natural position is through surgical intervention.

(Hammertoes are another example of a progressive toe deformity.)

The nature of your bunion will play a role in determining which kind of treatment path is right for you.

If you want to have a bunion treated without surgery, it’s best that you come to see us at the earliest possible opportunity. When you do, we may be able to slow—or perhaps even stop altogether—your bunion’s progression.

And if the bunion is already in an advanced stage and surgery’s the best option, you can take comfort knowing that we’ve been able to help many patients who were in the same situation.

No matter if conservative or surgical care is the best approach, we’d love the opportunity to help you find relief and keep this situation from becoming even worse.

If you have any questions or would like to schedule an appointment, please don’t hesitate to give us a call at (760) 568-0108 or contact us online today!


Dr. Harvey Danciger
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Dr. Harvey Danciger is a podiatrist and foot surgeon in Palm Desert, CA specializing in the foot and ankle
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