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Painful, ugly, shoe-spoiling bunions are a very common affliction, affecting all ages – not just the old. Are they really caused by fashionable shoes, is there any treatment apart from surgery and what does bunion surgery involve?

Even the otherwise flawless Victoria Beckham has been troubled by bunions which make ugly bulges in her expensive high-fashion shoes.

What exactly are bunions?

The term refers to a bony deformity of the big toe joint, known medically as hallux valgus.  (Hallux is the medical term for the big toe, and valgus means away from the midline of the foot). To understand exactly what this is you need to know the anatomy of this area. 

The base of each toe is joined to a metatarsal bone (the equivalent of the long bones in the back of the hands called metacarpals).  The metatarsals fan out from their base near the ankle, with the distance between them increasing as they approach the toes.  But in the case of bunions, the distance and angle at the base, between the first and second metatarsals, increases with time.  

Effect of shoes

The foot is now wider and shoes start to press painfullyon that deformed big toe joint. 

The pressure from shoes pushes the big toe towards the second toe, emphasising the deformity at the first joint – which ‘bulges’ on the side of the foot. 

As the condition progresses the second toe my lie over the top or ‘over-ride’ the big toe. This will lead to further pressure from, and distortion of, footwear.  Hard skin and corns may develop on top of the second toe, where it is rubbed by shoes. Walking will be difficult too, as the deformed foot cannot function as nature intended.

Rubbing of the enlarged big toe joint by shoes will cause pain, hard skin and corns, and the area may become inflamed – red, hot, painful and swollen – due to the friction and pressure from shoes.  A fluid-filled sac called a bursa sometimes develops over the joint to try to protect it from damage. As the bursa increases in size it will also be painfully rubbed by footwear and may even burst from all the friction.

The joint itself may also become damaged by the distortion of the foot, leading to degenerative changes i.e. arthritis to develop.  

So do shoes cause bunions?

No they don’t.  

We know this because bunions occur in unshod races ie people who don’t wear shoes.

  Also, although not as commonly as women, men - who generally don’t wear the type of shoes associated with bunions (high-heeled and narrow-toed ) - also develop bunions. And not all habitual wearers of such footwear develop bunions, so there are clearly other factors at work.

What we do know though, is that those types of footwear can make bunions worse and probably accelerate their development.  So there is still every reason to restrict wearing of high heels and ‘winkle-pickers’ to just those special occasions i.e. not wearing them daily.

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