Bunions: there's more you can do than you think
Your big toe leans in towards the other toes. On the inside of the foot there's a bump, and in narrow shoes it hurts. Many people who come in here add that their mother had it too. So it seems there's nothing to be done.
About a quarter of adults have a crooked big toe, and over the age of 65 more than a third. What I see is that it often affects one foot only, or one foot more than the other. That hardly fits with something that lies solely in your genes or your shoes.
What runs in the family
What you can inherit is softer connective tissue and more supple ligaments. What I also see is that you pick up a way of moving from the people you grew up with. If you walk like your father or mother, you load your feet as they did. That second part lives in your nervous system, and a movement pattern can be changed. Shoes play a smaller part than is often assumed.
What happens in the foot
As you walk, your weight rolls forward across the sole of the foot and you push off through the ball of the foot. That works best through the heads of the first and fifth metatarsals. With a bunion, the foot rolls inwards at push-off, so the pressure falls on the side of the big toe joint. That joint opens further and further, and the toe bone comes to sit askew on the metatarsal, like a beret that has slipped to one side. The tendon beneath the big toe ought to run between two small sesamoid bones. Instead it slides off to one side and pulls the toe further out of line.
Where it comes from
The foot rolling inwards rarely starts in the foot. What I often see is that the joints between the toes and the midfoot don't extend enough, you take small steps with a slightly bent knee, and your hip doesn't rotate outwards far enough.
There's a second place too. In the middle of the foot sits a wedge-shaped bone, the intermediate cuneiform, which closes the dome of the foot like the keystone of an arch. When you put weight on the foot, the talus tilts and this bone slides forward. The joints around it open towards the floor, so that the metatarsals come to lie flatter on the ground and the dome of the foot spreads and lowers. If that doesn't happen, the big toe pronates more.
The bump is your body's answer to movement that's missing elsewhere.
What you can do about it
If your feet hurt, practising walking is probably the last thing you feel like doing. Yet more mobility throughout the body is both the precondition and the solution. As soon as the rest of you moves more, the foot is less overloaded.
The work rarely begins at the toe. What's usually lacking lies higher up: enough outward rotation in the hip, extension in the knee and mobility in the ankle. The joints between the toes and the midfoot often don't extend enough either. Once movement returns there, the foot needs to roll inwards less at push-off.
There's also work to be done in the foot itself. You can strengthen the muscles of the foot so that it springs and the forefoot holds together better, and you learn to time your movements better.
If you're told your forefoot has dropped, the advice that often follows is to wear orthotic insoles. An insole supports the forefoot; what it doesn't do is teach the foot to spring by itself. So a dropped forefoot is no life sentence. The muscles that hold the forefoot together can be trained.
I'm often asked whether toe spreaders help. It depends on how you use them. They can make you more aware of the muscles in your foot if you use them to practise deliberately, spreading the forefoot without gripping with your toes. Wriggling them between your toes and then pottering about the house does little. The foot has to be able to spread and spring back while you walk, and that's something you learn in movement.
First I look at how you walk. Then we practise reintroducing lost mobility into your joints. Once you've regained the option of moving better, and have gained experience of the sensations in your feet, we can work more deeply on using your feet better. That's what it takes to reorganise the muscles and tendons of the foot. Through pressure, the foot passes essential information on to the body standing on top of it.
The tendon beneath your big toe has shortened, and it won't find its way back between the sesamoid bones by itself. That calls for Myofascial Release. If that doesn't fully succeed, some improvement is usually still possible. It asks for patience. Gradually, too, your nervous system responds with fewer alarm bells to what you feel in your feet.
If you develop a better walking pattern, your big toe may come to stand straighter and the bump may grow smaller, provided the big toe is still mobile.
Taking it further
Would you like to explore your own gait and make your feet stronger? You can, in personal training with Anatomy in Motion at my studio in Maastricht. If you'd rather work in a small group, there's the Walking with Ease class. Getting to know each other is free.