Hereditary Bunion Myth: Part III of III | By Dr. Ray McClanahan, DPM

You have probably heard the saying by Benjamin Franklin, “an ounce of prevention is better than a pound of cure.” Prevention is the best approach to achieving good health, but many times when it comes to painful health conditions, we do not implement strategies for prevention. Sometimes, we do not know how to prevent a painful health condition from occurring due to lack of education. Other times, we choose to ignore information that we do know regarding prevention, because we have not personally experienced the pain associated with the development of a preventable condition, like a bunion.

When I speak with people who have bunions, I meet a mix of people. Some have not been educated on how to prevent a bunion and have no idea their shoes are deforming their feet. Other people understand how their footwear is promoting bunion formation, yet choose to wear shoes that hold their big toe joints in partially dislocated positions for most of their waking hours to meet the standards of fashion, attractiveness, profession/workplace, and cultural norms.

In my experience, pain is the most powerful motivator that gets a person to address their bunion deformity.  Many people are barely observant of the subtle changes that are occurring to their toes over the course of their lifetime, but when they notice a painful red “bump” on the side of their foot, or their toes are overlapping, they begin to draw attention to their feet. In other words, these people did not prevent their bunion from occurring, and now need to decide upon an appropriate way of addressing their partially dislocated big toe. Sadly, many of these people are told that their problem is the result of faulty genes (hereditary), and will require surgical correction, permanent arch supports for life, and is prone to recurrence. This is what I was taught, and it is not correct.

Many people believe the hereditary hypothesis, which we disproved in part I and part II, and allow a surgeon to cut through their bones and place plates and screws into their foot. Having performed many bunion operations, I can personally attest to the ongoing problems that many people have after this surgery, even when meticulously performed.  The greatest misfortune these people endure is the lack of education regarding how their footwear caused their deformity and will cause a recurrence of their bunion, sometimes in just a few years. It is not uncommon to have one’s bunion “removed” more than once.

A better way to treat most bunions is to understand what caused the bunion and begin reversing or eliminating those factors. As we have carefully outlined in parts I and II, footwear is the primary cause of bunions, so any preventive program must teach people with bunions to choose footwear that is widest at the ends of their toes, based on the Shoe Liner Test™. Secondly, bunion reversal is hastened when a toe separator is used, especially a toe separator that will accommodate greater levels of correction over time – Correct Toes is the best toe separator to accomplish this. Correct Toes should visibly move the big toe away from the second toe. Best results are accomplished when a person with a bunion can wear Correct Toes in natural footwear all day, for all of their activities. Finally, because people with bunions have worn shoes with tapered toe boxes for most of their lives, they have caused an imbalance in many of the small arch muscles in their feet. In the case of bunion deformity, the abductor hallucis muscle becomes overstretched and dysfunctional, and the adductor hallucis muscle becomes shortened and progressively dislocates the big toe (see the video below for further explanation). This requires progressive rehabilitation exercises to correct.

In conclusion, you are likely reading this because you are like most people and have not prevented your bunion from occurring. No problem – you are normal. Don’t feel bad, very few people have been taught how to prevent a bunion.

Here are the steps to bunion reversal, no matter what stage of bunion you have developed:

1). Choose footwear based on Shoe Liner Test. Your footwear MUST be widest at the ends of the toes, or you will not be able to reverse your bunion deformity. Wide shoes are not sufficient, they must be widest at the ENDS of the toes.

2). Wear Correct Toes toe separators and increase correction over time, per product instructions.

3). Perform the bunion stretch and foot strengthening exercises.

4). Respect the need for your body to change over time, as it did as you developed your bunion.

5). Take a picture of your bunion before you begin your reversal program, and progressively over time, to help you observe the subtle corrections.

6). Send us your before and after pictures, which are better than any form of evidence that bunions are reversible without surgery.

In our experience, the only type of bunion that cannot be progressively reversed with this program is when the big toe joint is fused and has no motion. In this situation, surgery might be a good option and then following up with this program, which is also a maintenance program.

Please help us get this information out to your friends and family.

In Health,

Dr. Ray

17 thoughts on “Hereditary Bunion Myth: Part III of III | By Dr. Ray McClanahan, DPM”

  1. I have been wearing Five Finger shoes now almost two years. The shoes themselves hold my toes apart and allow my toes and intrinsic muscles to flex and move better than tight toe box shoes. I am now where not only my toes and arch are much stronger, but also my legs, back, hip, and knees are as well. I may never have back problems, knee, or hip problems as a result of using barefoot shoes.

    1. That’s fantastic, Richard! So happy to hear that natural footwear is having positive effects on your entire body.

  2. I started developing bunions at the age of 15. By 18, I had pretty large bunions with my big toes pointing towards the other toes. Why would such a young person develop bunions? I wore athletic shoes (granted, they were “regular” running shoes) and flip flops in the summer. It was hardly the tapered shoes most adults wear.

    1. Keep in mind that conventional athletic shoes, possess those attributes (tapered toe box, heel elevation, toe spring, and a rigid sole) that can negatively affect your foot’s position and function. Wearing this type of footwear over many years starts to cause foot conditions, like bunions. An individual’s physiology and soft tissue elasticity can also play a role. This renders some feet the ability to return to their natural foot shape after removing tapered toebox footwear and other feet to more quickly take on the unnatural shape of the footwear permanently.

  3. I have Taylor’s bunions. I’ve had them all my life and for a very long time didn’t know they were a thing. Just thought I was cursed with wide feet. Anything that can be done for Taylor’s bunions?

  4. Interesting series. I respect your saying that bunions are not hereditary. How is it then that some get them and some don’t, even they were identical shoes? Not to mention hammer toes on top of it. Also, if not hereditary, how is it that bunions are observed in the parents and children and may skip one? there got to be a genetic factor at play as well as environmental factor. I switched to minimalist and wide toe box shoes years ago and would love to see my bunion (only in left foot) improve. As far as hammer toes (2nd toe in both feet) isn’t surgery the only option (Dr Mark went through it)? It’s a real pain as it interfere with my running and walking and I lose my nail again and again. Thanks!

    1. While the bunion itself is not genetic, there are certain soft tissue principles that can impact bunion development within family lines. For example, genetic factors control foot width, as well as soft tissue flexibility and integrity, leading conventionally shaped footwear to have a greater impact on individuals with wider feet. Additionally, the amount of time spent wearing conventional shoes, as well as the activities performed while wearing conventional shoes, can have varying effects on the development of bunions.

      Hammertoes are the result of a muscular imbalance between the long extensor tendons across the top of the foot, and the short arch intrinsic muscles and flexor tendons on the bottom of the foot. With years of wearing conventional footwear where the heels are elevated, toes are lifted up and squished together, the lesser toes are held in an unnatural position. Shoes that are too small may also force your toes into a curled position. Over time, your toe tendons adjust to this positioning, causing your toe or toes to hold a hammered shape. Conservative treatment may be helpful, or fully corrective for a flexible hammertoe. A toe-spacer like Correct Toes will encourage natural alignment of the toe. Metatarsal Pads will encourage top-of-foot lengthening and relaxing, promote the return of any overextended toes to their normal anatomical position, and encourage the return of your forefoot fat pad to a place that supports your metatarsal heads. Stretches like the Toe Extensor Stretch or Hammertoe Stretch, while avoiding any stretch or motion that lifts the toes into dorsiflexion (ex. lunges, squats, and certain yoga positions) can help to release and relax both the toe extensors and toe flexors.

  5. Amazing video, it makes so much sense! And surgery seems overkill. I’ve been wearing my correcttoes for a while now and my feet are almost normal shape again. I do feel a lumpy area on the bottom of my right arch and I’m wondering if that my go away as well? Thank you for a great product!

    1. So glad to hear your feet are feeling better! Without being able assess your feet in office, we can’t know for sure what might be causing this “lumpy area,” and recommend an examination by a podiatrist or another physician. However, we will share that sometimes a “lump” of dead tissue can be found along the medial longitudinal arch towards the heel that is called plantar fasciosis, especially after chronic plantar fasciitis. Conventional footwear compresses and elevates the big toe, which can cause the abductor hallucis muscle and the medial plantar fascia band to compress the tibialis posterior artery, which provides blood flow to the plantar fascia. Correct Toes, along with natural footwear that allows your toes to lay flat and splay wide, can help to release the tension on the abductor hallucis muscle and the medial plantar fascia band, restoring circulation, and facilitating removal of fasciotic accumulation and delivery of oxygen to plantar fascia tissue.

  6. I have been wearing correct toes for about 4 months now on the recommendation of Dr. Splichal, My bunions are quite severe and she advised I would not be able to eliminate the protrusion without surgery. I have been doing short foot, single leg squats and dead leg lifts while wearing the correct toes as well as using the rad roller during the past few months as well on her recommendation for preventing the bunions from worsening.

    I looked at your recommended foot strengthening exercise list and thought I may add to my regime, does it make sense to them with or without the correct toes on? I tried the toe lift (without correct toes on) and could only do if i pressed the other toes down with my fingers. Is this because my bunions are too severe or is this something I can work up to with time?

    1. While we recommend wearing Correct Toes while being active, the specific foot strengthening exercises found in this video should be done without Correct Toes on. The first place to start is the range of motion of your big toe. If your big toe is still mobile in that you are able to lift (extend) and curl (flex) your big toe by moving it with your hands, then foot strengthening exercises should be a great help for you over time. With bunions, we often see shortening and tightening of the muscle between the first and second metatarsals, called the adductor hallucis. This video demonstrates the bunion stretch and soft tissue release to help lengthen and relax that muscle. Here is an older video with some more bunion reversal exercises. Here are some strengthening exercises you can do while wearing Correct Toes. We hope this helps!

  7. Hello, I have been a big fan of this ‘correct toes’ movement ever since I stumbled across it on YouTube some years ago. I have had mild bunion formations ever since I was young. They have been getting much worse and painful as I get older, specifically I was experiencing problems running with constant ‘shin splints’. Conventional podiatry was struggling/failing to fix the problem. Although it helped me discover my running form was poor (probably a result of conventional shoes that adjust how your body thinks it needs/should run) I couldn’t seem to solve the problem of my bunions/weird feet and second toe bending/pain.

    Added to the fact my family has a rich history of knee and hip problems (replacements) I figured my feet, no coping too well in conventional footwear over years and years, were most likely the ‘genetic’ component to the families/my issues.

    To the best of my knowledge, I entirely agree that shoe fashion and the use of ‘unnaturally’ shaped footwear deform our feet, especially when we are young. It has been a real eye opener seeing the ways we as humans follow mainstream societal patterns so blindly/unknowingly, even when detrimental to our health – this applies to so many aspects of life, not just footwear.

    Incorporating CT into my life and changing my footwear habits seemed like a good choice, and well I didn’t really have much too loose anyway!

    I‘m now onto my third pair of correct toes, having gone through periods of determination to use natural footwear/CT, and other times when I conform back to regular shoes to ‘fit in’.

    However, I have recently spent the last 6 months or so giving it a really good try. Going barefoot or wearing virtually only zero drop, wide toe shoes (although not always fully ‘natural’, like using Birkenstock’s), with correct toes. I have also really enjoyed transitioning to running in CT and vivobarefoot stealth 2’s (it did take a while getting used to this, but seems to have sorted the shin splints!). More recently I have also added in metatarsal pads.

    Finally to my question/concern – although I still agree with the principle of trying to give the foot a more natural environment to operate (especially when running!) I’m finding that although I don’t have pain in my toes, which is great, the actual bunion ‘bumps’ seem to be getting bigger and I fear my first metatarsal is actually becoming even more out of place/spectated from the second. And adding to this, my toes/feet return strait back to their tapered appearance when I take off CT. Further, if I wear bare feet without correct toes I get rather painful second toes and just overall uncontrollable joints after prolonged periods (not just walking around the house). This has been concerning as I love walking barefoot, but now fear it for long periods as I get pain!

    I’m only in my 20’s and really don’t want to have surgery on my feet. However, what are the risks/complications of using CT if they only remove pain whilst wearing and possibly may be making the problem worse. Could this be down to having very poor foot/anatomy genetics that aren’t allowing my feet to form a more natural position? Should I start considering conventional podiatry again as CT just may not be right for me, or am I doing something else wrong?

    Any recommendations/advice would be great! Thanks.

    1. Hello James!

      It is pretty rare for bunions to continue to dislocate while wearing Correct Toes, and I definitely don’t think Correct Toes would cause your bunions to worsen. First, I would say be sure you’re also doing bunion reversal exercises and bunion stretch and soft tissue release. You can also consider adding a shim to the hollow cavity in the first pylon between the big toe and 2nd toe, try some different modifications to better help the Correct Toes fit to your feet, and doing some foot strengthening exercises. I think you would be a great candidate for a remote consultation with one of our doctors from our Portland, OR clinic Northwest Foot & Ankle.

  8. So I must say, my dad was born with one bunion on one foot and gave it to my sister and I on both feet. Ive had them since I was a baby. We tried everything, spacers, things to wear at night to stretch them out, sole inserts. I have only ever worn sneakers or boots, mostly for comfort purposes. But even in sneakers now I am finding the bunions are hurting. I am 29 years old. Is it worth getting surgery, will it get worse?

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