This is a very common question amongst patients and the real answer is: it depends. The largest determining factor in the development of bunions and hammertoes is genetic inheritance of a foot type. Like many other health conditions, a combination of genetic and environmental factors contribute to the overall severity of a disease or disorder and bunions and hammertoes are no exception.
An excellent analogy is smoking cigarettes. While we know that cigarettes increase the risk of lung cancer, not everyone who smokes will get lung cancer in their life. And there are those who do not smoke at all that get lung cancer, which is due to genetic inheritance. However, those who have an increased risk for lung cancer will further increase that risk by smoking or being exposed to cigarette smoke. In the same way, those who have an increased risk for bunions and hammertoes can greatly increase their risk by wearing poorly supportive shoes, and high heels fall into this category.
The most common foot type that makes a person prone for bunions and hammertoes is a hyperflexible or hypermobile foot type. In this foot type a person has an arch when they are not standing but the arch collapses with weight bearing causing what is called a flexible flat foot (or collapsing pes valgus). When the arch collapses, it causes instability in the foot which changes the way the foot pushes the body forward in space, causing the person to push more off the side of the foot than from the front. This pressure puts the joints where the foot meets the toes (or metatarso-phalangeal joints) at a mechanical disadvantage and causes bunions and hammertoes.
The best way to counteract the process of a collapsing arch is with proper arch support, which consists of prefabricated and custom types. Prefabricated orthotics are pre-made and shaped with an average foot type in mind. This type can work well for many people. However, arches that collapse severely usually require custom orthotics for proper support. Custom orthotics are made by taking an exact mold of the person’s foot and placing prescription changes into the orthotic to improve the person’s mechanics.
The doctors at Advanced Foot and Ankle Center have specialized experience and training to treat all types of foot and ankle conditions and are very well versed in all types of orthotic inserts. Call for an appointment today to have your feet evaluated.
Dr. Eric Silvers, DPM, FACFAS
Dr. Dustin Lloyd, DPM, AACFAS
Dr. Robert Hadfield, DPM, AACFAS
- You don’t have to suffer from foot pain. Don’t ignore your feet. If you are experiencing pain contact Advanced Foot and Ankle Center in McKinney and Prosper to be seen for an evaluation.
- Pay attention to changes in color or temperature on your feet. Look for thick or discolored nails as this may be a sign of toenail fungus. Check for cracks or cuts in your feet as they can be a pathway for bacteria and infection. Peeling skin on the bottom of your feet may indicate Athletes Foot. New moles or freckles that appear abnormal in their shape or color may be a sign of skin cancer. Inspect your feet regularly and be aware of any changes.
- Wash your feet daily with soap and water. Be sure to clean well between your toes. It is not simply enough to stand in the shower and let the dirty water and soap rinse off of them.
- Try to trim your toenails strait across and be sure not to cut the nails into the corners as it can lead to an ingrown toenail.
- Make sure you are wearing a proper fitting shoe. It is best to be fitted by a professional to ensure proper width and length. A good trick if you are unable to be professionally fitted is to have someone trace your footprint on a piece of paper while you are standing. Then any shoe that you have or are purchasing you can simply pull the foot bed insert out of the shoe and be sure it is proper length and width. Do your shoe shopping later in the day when your feet are most swollen from activities throughout the day.
- Select and wear an appropriate shoe for the activity you are participating in. For example running shoes when running, court shoes when playing tennis, hiking boots when walking hiking trails and uneven terrain.
- Don’t wear the same pair of shoes every day. Remove the insert and let the shoe fully dry from your daily perspiration before wearing again. This can decrease the chances of catching a fungal infection on the skin or nails of your feet as fungus likes warm, dark, moist environments.
- Avoid walking barefooted as it will increase the change of injury to the feet.
- When you wear sandals or are barefoot at the pool don’t forget to apply sunscreen frequently. Your feet are susceptible to skin cancer and UV radiation just as much as the rest of your body.
- If you are diabetic schedule a foot check up at least once a year to evaluate your blood flow as well as any sensory deficits you might be unaware of.
Contact Advanced Foot and Ankle Center at 972-542-2155 to discuss any foot or ankle care needs.
Eric Silvers, DPM, FACFAS
Robert Hadfield, DPM, AACFAS
Dustin Lloyd, DPM, AACFAS
A bunion is not simply a bump on the side of the foot. It is a complex change in the shape of the big toe joint (first metatarso-phalangeal joint) that leads to increasing pain and arthritis as it gets worse. Though many bunions are not painful, as they get worse they can become more and more painful, which leads to difficulty in walking and doing the normal activities of life.
The medical name for a bunion is Hallux Abducto Valgus, which means the big toe and the bone behind the big toe (called the first metatarsal) become angled and the cartilage, which provides the lubricant for the joint to move smoothly, becomes shifted. This happens because the big toe moves away from the center of the body and the first metatarsal moves closer to the center of the body. Because the cartilage is shifted, it wears away at a faster rate than normal and can lead to early arthritis and severe pain as time passes. Usually as the bump gets larger and the toe gets pushed over farther, the pain and arthritis get worse.
There are several causes of bunions, most of which are hereditary. Flat foot and flexible flat foot are among the most common causes. Other causes include trauma/fracture, high arches (also known as cavus foot), hereditary nerve problems and in some cases there is no known cause. The reason a flat foot most often causes a bunion is because of the way a person walks when there is not an arch to properly support the foot. Normally the arch helps the foot push the body forward during walking or running. With a flat foot, there is no arch to help push the body forward, so the foot turns outward instead, which puts the big toe in a bad position and the body pushes on the big toe from the side, instead of from the bottom. The big toe is not designed to be pushed from the side, so it gets forced away from the center of the body, leading to a shift in the toe and a larger bump on the side of the metatarsal bone.
So, the strategy to help improve the pain and prevent the bunion from getting worse is to support the arch. This support can come in the form of shoes, pre-made orthotics and custom orthotics. A shoe alone is usually not enough to properly support the arch if someone has a very flat foot or very flexible foot. Shoes are made as a blank and usually have very little arch support. Orthotics provide a better and more custom fit to any shoe. Pre-made orthotics are designed as an average of everyone’s foot type, but some can be selected for certain foot types to fit a person somewhat better. Many people do extremely well with pre-made orthotics. Custom orthotics are made by taking a mold of the foot and making an orthotic that is exactly made for the person. They are made of stronger and more long-lasting materials also.
There are other devices that are made to help with bunion pain. A bunion splint is a brace that helps straighten the big toe, which helps to put the cartilage back where it belongs. This splint does not make the toe grow back where it belongs, but it does help to make the toe work better as long as it is worn. A toe separator is a device that is put between the big toe and 2nd toe, keeping them separated. This can also help the big to cartilage be in a better position, but like the bunion splint, it only works when worn and will not permanently fix the bunion.
Also, there are medications and injections that can help the pain of a bunion. The pain from a bunion is most often due to inflammation (swelling of the joint and tissues) and medications can help to slow it down. Non steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help with the swelling that is the cause of the pain. An injection of steroid into the joint also can help reduce the inflammation.
If the treatments listed above do not work well enough, surgery to correct the position of the joint is the next step. Many different operations can be performed to place the joint in the right position to keep the cartilage from wearing down and decrease the pain. Which operation is chosen is based on many things and x-rays of the foot are very important in making the decision. The doctor looks at the position of the big toe and metatarsal as well as the other joints of the foot to decide which operation is best. The recovery time is different depending on which operation is needed.
In most cases, the operation needed is a shifting of the metatarsal bone, to bring it back to where it belongs. To do this, the bone must be cut and held in place with screws. These screws stay in the bone and usually don’t have to be removed. The big toe must also be shifted, but usually doesn’t need a bone cut. The large bump on the side of the foot is also removed. When finished, the big toe is straighter and the bump is gone. The joint also moves more smoothly and the pain is improved. The recovery period for this operation is a little different for each person, but on average the patient walks with a special shoe for about 4-6 weeks, which is the time it takes for the bone to heal. After that, the patient starts wearing a tennis shoe and slowly goes back to regular activities. The patient will also need to do exercises to keep the big toe joint moving and may need to have physical therapy for the best results. The incision for this operation is usually around 2 inches long and is put in an area where it heals very well with a small scar.
In some cases, the operation needed is a little more complicated. In people with very flexible feet, or for bunions that are very large, a different operation is needed. This operation has a bone cut also, but it is done in a different area and it is necessary to take away one of the joints to make the flexibility of the foot more normal. Screws and a plate are usually used to hold the bone in the right position and bring the metatarsal back where it belongs. The big toe is straightened and the bump is removed, just like in the other operation. The recovery time for this operation is a little longer. Usually the patient is in a cast for 6 weeks, followed by walking in a boot for a few weeks. Because this operation is a little more complicated, the scar is usually a little longer, but is still small and most often heals so that it is not easy to see.
There are many other operations for bunions but these two are the most commonly used at Advanced Foot and Ankle Center. With every bunion, the doctors at Advanced Foot and Ankle center take great care when looking at all parts of the problem and then select the best treatment. Whether you need orthotics, a splint or surgery, you and your bunion will be given the time and care they deserve.
What Is the Right Type of Athletic Shoe For Me?
This is a very frequent question asked in the office and the short answer is: it depends. There are many different foot types and shoe selection is based on this as well as other factors including the shape of the leg, positioning and flexibility of the knee and hip. The mechanics of the human foot are very complex and over a century of research has been conducted to better understand its motions and correct problems. There are three main foot types: flat arch (planus), average arch (rectus) and high arch (cavus), but within this category there are many subtypes and each has distinct features.
To begin with most shoes on their own are inadequate to support most people’s feet. Even a very good athletic shoe is a blank on the inside, similar to a pair of glasses without a prescription in the lenses. Most quality shoe manufacturers do this on purpose in anticipation of a person having an insole that matches their proper foot type. Shoes in their construction, in particular athletic shoes, do have some built in systems to help assist the foot in proper function.
Most quality athletic shoes have three basic soles which mirror the three main foot types. Pronation control shoes target the improper mechanics associated with a flat arch and try to help keep the arch up during walking or running. A neutral shoe is one that purposely does not assist in arch function and is for those with a average arch. A supination control shoe is for those with high arches and is the opposite in its function to the pronation control shoe. Selecting the incorrect type of shoe for your foot type can lead to a lot of pain and future foot issues.
Selecting the proper category of shoe is also important and the right choice depends on your desired activities. There are hundreds of different categories of shoes from running to walking, cross trainer to stability. Each shoe manufacturer has different guidelines for determining how their shoes fit into each of these categories. In general, a running shoe works very well for nearly all activities. There are millions of dollars invested in research with running shoes and they are usually of the highest quality, although the rule is not always true that you get what you pay for.
In many cases athletic shoes are designed for fashion over function and can cost hundreds of dollars despite not being well made for a person’s feet. There are many features of shoes made for fashion that make them difficult to wear and can lead to pain. The first is the toe box, which can be very narrow in many cases and on the outside (the side by the baby toe) there is often a taper that presses on the toe. Those with hammertoes often have great difficulty wearing closed toed shoes as a result of a tight toe box or a dramatic taper. The shank (or midsole) is very weak in minimalist shoes, which are light weight and very popular currently. The loss of stability in the shank can lead to arch pain in those with flexible arches or flat arches.
The most important features a quality athletic shoe provides are shock absorption and and assistance in proper transition of weight from the heel to the ball of the foot. Many of the current trends in athletic shoes is to go away from these two features in order to provide a minimalist, or very lightweight shoe. When shock absorption and proper transition are lost from the shoe, the foot and leg must take the increased force, which can lead to shin splints, foot, ankle, knee, hip and back pain.
No matter what type of athletic shoe is right for you, they are just the starting point. A quality insole (whether prefabricated or custom) that matches your foot type is key to proper mechanics of the foot, preventing pain and other foot issues. The doctors at Advanced Foot and Ankle have significant training and experience in all aspects of foot and ankle care and can help you find the right shoe and insole for your particular foot type. Many quality athletic shoes are available in the office to meet your needs including the Spira® shoe line, which reduces shock and assists in proper transition of the weight from the heel to the ball of the foot. Call for an appointment today.
Eric M. Silvers, DPM, FACFAS
Robert A. Hadfield, DPM, AACFAS
Dustin M. Lloyd, DPM, AACFAS