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

Hereditary_bunion-1

In spite of the fact that the medical community has made advances in the care of many common medical conditions, the treatment of bunion deformity is still locked in the dark ages.

Today’s podiatric students and residents are being taught that bunions are hereditary, represent a bone structure problem, and require surgery for definitive treatment. They are being taught that the progression of bunions can be slowed by supporting the arch (subtalar joint) with orthotic devices. They are encouraged to recommend wide width footwear to their future patients, which does not fix the problem, as you will see below.

This perspective represents the current standard of care in podiatric education and practice, but is it based in evidence?

The short answer is no.

There are several clues as well as self-evident medical facts, that point to the flaws in the presently accepted educational approach and treatment of bunion deformity.

Humans are not born with bunions. In all but the exceedingly rare case, human babies are born with toes that spread wider than the balls of their feet. We even seem to respect this anatomical reality by manufacturing footwear for babies that are the same shape as their natural feet. However, around the age of 3, we begin changing the shape of the feet of infants by fitting them in footwear that no longer respects natural human foot anatomy, and we start squeezing their toes together. We begin fitting them in shoes that are widest at the balls of their feet, as opposed to where natural feet are widest: at the ends of the toes. This is where bunion deformity begins.

Baby-stuff

Throughout the lives of most humans in shoe wearing societies, they will continue to purchase footwear that is widest at the balls of the feet and gets narrower in the toebox. Consequently, their feet will become shaped like their shoes. This happens because most footwear available to them is manufactured this way, and the current system for measuring feet, the Brannock device, gives feet their width measurement at the ball of the foot. Nearly everyone’s feet have become misshaped by their shoes early in life, so we fail to recognize that there is nothing natural about the shape of our feet. We have created a new normal, not without significant negative consequences, which eventually show up as pain and disability.

Brannock

A group of researchers from Harvard recently published an article on the “Framingham Foot Study” in Arthritis Care & Research where they concluded that bunions are highly hereditable. The problem with their conclusion is that they failed to control for the footwear that their research subjects were wearing, and had worn over their entire lives. Employing the same reasoning that they used to arrive at their conclusion, we could conclude that long necks are highly hereditable in females in Bangladesh who wear rings on their necks, or that cone shaped skulls are highly hereditable in the African tribes who tightly bandage the skulls of their newborns to create a cone shaped head.

Body_modify

We are not observing correlation here. We are clearly identifying causation. Brass rings cause long necks. Tight bandaging of the skull at birth causes long heads. Shoes that progressively dislocate the big toes, over the course of a lifetime, cause bunions in nearly all cases.

If the researchers at Harvard would have looked at the footwear their subjects wore throughout their life, they would see that what is hereditable is feet that are wider than most of the footwear those individuals have worn over the course of their lives. We check this on every patient that comes in to our clinic by using the shoe liner test, and what we’ve seen is that nearly 100% of patients with bunions have feet that are wider than their footwear. We tell them that their shoes are narrower than their feet, and they confirm they have always struggled to find shoes for their “wide feet”.

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Another hereditable feature that plays into the development of bunion deformity is soft tissue elasticity. 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.

Watch our Hereditary Bunion Myth video here.

To summarize – bunions are non-hereditable, preventable and reversible progressive dislocations of the big toe joint, caused by the tapering toebox of footwear. They do not represent a bone structure problem, a growth of bone, nor a calcium deposit. They are also not fixed with surgery, nor are they slowed by arch supports or orthotics. They are, in fact, prone to continued symptoms, reoccurrence and failure when these methods are applied without the new, scientifically credible method of bunion prevention and reversal I will outline in parts 2 and 3 of this article. This new method is natural, successful, cost effective, and avoids many of the known risks inherent to the commonly accepted methodology.

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

  1. Great article Dr. Ray! Your examples of neck rings and tight skull bandages give a good visual for everyone to understand how shoes do impact our feet over time. I would like to point out the other missing factor in bunion formation and bunion treatment: postural alignment. Most people have a larger bunion on one foot than the other and many people only have a bunion on one foot. How can this be when they are wearing the same shoes on both feet? It is because bunions are greatly affected by walking and running gait and when someone has posture imbalances, their gait is not balanced. This imbalanced gait and foot strike will cause unnatural forces on one foot that will cause or exacerbate the bunion formation. The only way to prevent and/or cure bunions, is to correct the posture imbalances and re-align and balance the person’s joints.

      1. Postural alignment is the result of muscles functioning well. The principles of “good” postural alignment are: balance and vertical load. Our body is designed to be balanced both left to right and front to back. Our major load joints are designed to be vertically aligned: ankles, knees, hips, and shoulders stacked one on top the the next. Bones don’t move bones, muscles move bones. Our posture is a result of muscles holding our bones in place. If we have strong, flexible, and balanced muscles, we will maintain good postural alignment. If you’d like to learn more, go to my website and sign up for a free posture evaluation.

  2. This is a great article, clear and informative. It reminds me a lot of the work of Christine Kent with pelvic organ prolapse, the mechanisms of pelvic organ support, and modern medicine’s persistent and pernicious mis-understanding of it. Bad science leads to bad results. Keep on educating! 🙂

  3. Hi doc
    I agree with you but I wonder if nutrition might have something to do with the skeletal development which we see happen with dental deformity. In any case I’m not sure that I can expect my bunions/valgus deformity to change since I’ve been wearing correct toes for a few years now. I still like using them because my balance is better and my feet are gradually getting stronger even though the deformity has not changed. I’ve spent a lot of time either barefoot or in lem shoes with the correct toes and done lots of foot exercises running walking stretching and massaging. I feel that I could handle a larger correct toe correction and could probably benefit from some compression of the distal 1st metatarsal to help change the angle a little more?
    Any thoughts
    Mike cocco DC

    1. I’ve been using the Correct Toes for a few years, too, and still get quite a good deal of knee and hip pain when I run only with the Correct Toes in the same way that running only with my orthotics causes pain. When I run in both orthotics AND Correct Toes, lo and behold, it’s a huge relief and I feel like my legs are better aligned and I don’t have knock knees and grizzle in the knee caps afterwards. I realise using both together is not recommended but instinctively it feels right at least while running and I know I am saving my joints. When walking around I’ll just use Correct Toes and metatarsal pads and I do all the foot exercises and hours of foam rolling per week. My balance is much better. It might take me 20 years to realign myself and my feet might have been too far gone to have much hope for much change with Correct Toes alone, but I think as a tool amongst others, they are helping. At least I’m not doing damage when running.

  4. Please talk more about how to correct this problem. I have this problem on my right foot – podiatrist said it would just get worse, nothing we could do about it.

    1. Hi Becky,

      Having a bunion can be frustrating and painful, but there are definitely steps you can take to combat it! Here are a few ways to beat your bunion:

      1) Aligning toes with a toe-spacer like Correct Toes. Many of our customers and patients have been able to reverse the progress of their bunions through proper use of Correct Toes.
      2) Performing range of motion exercises and tissue releases like the Bunion Stretch. Here is a link to the Bunion Stretch: https://www.youtube.com/watch?v=q5Ov6LMISvU&feature=youtu.be
      3) Finally, wearing shoes that are flat, flexible and widest at the ends of the toes can always help.

      Hope this helps!

  5. Great article! I teach this and see this as I travel all around the country lecturing and talking to people with bunions. I am yet to see anyone with a bunion that hasn’t worn modern footwear with a tapered toe box. I have seen many people who have had incredible success treating their bunions by using shoes that are actually shaped like feet and don’t have elevated heels, and even more success if they use Correct Toes. I tell people all the time, you may think you have a genetic disposition to have bunions, but it has to be set off by wearing shoes that are shaped like them!

  6. Spot on. I wonder whether toe length also plays a part. I have long toes and, by the laws of physics, the force applied to the end of the big toe is therefore commensurately larger. Having worn shoes with high heels and tapered toe boxes for all but the last few years of my adult life, I’m can’t really be surprised that I now have bunions. I’ve been using correct toes and walking barefoot whenever possible for a few years now – when I’m standing I can use my foot muscles to largely straighten my toe, but sadly the bunion protrusion doesn’t disappear and when there is not the friction from the ground to hold the toe in place it reverts to its inward slant. I wish I’d known earlier and am now quite fanatical about stressing to my children and grandchild the importance of shoes that do no not distort the foot’s natural functioning.

    1. Hi Susan,

      Hope you’re having an excellent day! Toe length can also definitely factor in–especially when your shoes may have been too short in addition to being too narrow. When our toes are crammed against the end of a shoe, it creates a lot of pressure at the joints. Sorry to hear your bunion has progressed so far, but it is best to take a better late than never approach! Your feet are still adaptable, and progress can still be made. It’s good to hear that you’re making sure that your children and grand-children are in good shoes. When we are young our feet are especially malleable, meaning that proper footwear is critical. Please always feel free to reach out if you have any questions!

  7. I’ve been using Correct Toes for over three years now, and my feet love them. I hate taking them off!

    A perhaps unrelated question: Any thoughts on Thai style foot massage, particularly in relation to an existing (mild) bunion? (The kind where they jab your feet with wooden sticks and otherwise manipulate, sometimes with considerable force).

    If time permits, a quick answer would be greatly appreciated, as I’m currently based in Thailand where such massage is very affordable.

  8. Hi i’m 21 years old and month ago i got my bunion. I visited doctor and she told me that operation can take care of bunions. I absolutely try correct toes. I hope it will work. Because i’m young and i’m scared of operations.

    1. Hi Inge,

      Please do try Correct Toes! They’re a great non-surgical option. If you ever need any help transitioning into the Correct Toes, please feel free to give us a call at 503-243-2699. Our trained customer service operatives would be happy to help.

  9. Wonderful article, Dr. Ray! The idea that bunions are hereditary is such a pervasive misconception, and it’s a shame how it’s perpetuated by the (generally well-meaning) medical community. It’s always fascinating for me to travel to parts of Asia where entire societies wear mainly flip-flops. Adults, young and old, have straight, splayed toes. No bunions (or hammertoes or other crooked toes) anywhere! Thank you for continually educating and helping all people achieve optimal foot health.

    1. It’s a shame that not just bunions are blamed on genetics and considered hereditary but so are “bad knees”, “bad backs”, migraine headaches, osteoarthritis, degenerative disc disease, and the list goes on and on. Genetics determine hair and eye color, but do not guarantee us a lifetime of chronic pain. Our lifestyle – how we move – determines whether we develop knee, back, or shoulder pain, and if we change our lifestyle and environment we can become pain free again. Myself, I wouldn’t trust a healthcare practitioner that blames our problems on genetics, I’d quickly find another practitioner to go to.

  10. When will the remaining parts of the article be posted? I refuse to let soar feet effect my quality of life.

  11. What do you have for Morton’s neuroma? I use Correct Toes and it has helped some things but not others.

    1. Hi Jacquelyn,

      Thanks so much for checking out the article. It’s good to hear that you are already using Correct Toes! Many of our patients who suffer from Morton’s Neuroma have found a lot of relief through using them. Other than that, we don’t have any other specific products to treat a Morton’s Neuroma. That said, for more information on ways to combat Morton’s Neuromas, check out this page here. You can also find our video on neuroma care here. If you are still looking for more information, we offer remote consults at our clinic and we would love to help you!

  12. I have worn wide shoes my entire adult life and mid to late teens. Every female on my father’s side has bunions, including myself. I have never worn pointy shoes and I have always worn sneakers that are for wide feet. If I don’t have sneakers on I wear ballet flats. I can’t wear heels because of the bunion on my left foot has gotten so bad it’s painful to squeeze into anything with a heel. So my question is, if it’s not hereditary then how has this happened?

    1. Hi Erika, Great question. When shoes can’t be blamed for bunions, and genetics are not to blame, the answer comes down to gait imbalances. If you have great postural alignment your gait will be smooth, natural, and efficient and you won’t develop bunions. But if you have posture imbalances they will affect your gait and cause your foot strike to be compromised. The compromised foot strike can create increased forces that deform the foot and big toe and cause bunions. You can learn more in this article I wrote: http://www.oregonexercisetherapy.com/blog/bunions

  13. Waiting for Parts II and III of this 3 part series. I find this fascinating and personally true. When will Parts II and III be posted? I didn’t see them yet and today is May 28th.

    1. Hi Patricia,

      We appreciate your eagerness for the next parts in the series–we share your excitement! Unfortunately Dr. McClanahan has a pretty heavy patient load right now, so progress is a bit slow. That said, Dr. McClanahan is hard at work. Hopefully we’ll see the next parts very soon!

  14. Thank you Dr. Ray for this well written article. I am a Thai Yoga Massage therapist and yoga instructor. I find that structural body mechanics can be altered to its natural state, if the body is positioned with just enough pressure and muscle memory through breath work (and in the examples of long necks, coned heads and even feet binding, we can alter our bodies in an unfavorable/unnatural state as well).

    This article reminds me of the parallel that if some patients are more susceptible to receiving bunions (lets say heredity: in regards to the bones being more impressionable than other patient’s genetic make up). It makes me think of patients that have genetically stronger enamel, or patients that naturally have a higher pH in their saliva to naturally deter abscesses/cavities, or patients that have been diagnosed with scoliosis… this list can and does go on, but the common denominator is that if we look into our history to find ways to strengthen the areas of our bodies that we are genetically weaker, then we can find solutions to help ease the aging process of wear and tear on our bodies.

    In my professional experience, I have found and I’m sure you have too Dr. Ray that the body is quite resilient in it’s evolution to cope and heal.

    If we know that we have breast cancer, heart disease, high blood pressure ect in our family history and are willing to change our lifestyles to lower the risks, why not approach our anatomical structure in the same way?

    Thank you for your service to the community.

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