Bunions are one of the most misunderstood
musculoskeletal issues we are faced with today. This is a shame, since they affect more than
65 million Americans and millions more around the globe, yet the fixes for this problem
are actually pretty simple. So, in this video I’ll be taking you through
the common causes of bunions and how to fix them. For those of you who are new to the channel,
my name is Chris and I’m a sports and exercise scientist. This channel is dedicated to teaching you
how to build your athleticism from the ground, up. Our feet form the foundation for our upright
bodies and are the only connection we have to the ground for all upright movements. We therefore ought to then pay close attention
to how our feet are behaving if we want to perform at our best and remain injury free. Bunions are one of the signs that our feet
are dysfunctional. Known as “hallux valgus” in the scientific
literature, bunions are the result of a misaligned great toe, whereby the first metatarsal head
shifts its position laterally toward the other four toes instead of maintaining a proper,
straight line of action. Over time, the metatarsal phalangeal joint
(also known as the MTP joint or MPJ ) at the base of the big toe starts to protrude and
becomes inflamed. This often leads to discomfort during physical
exercise and even basic actions such as walking. So, what causes bunions and how can we fix
them? Well, there are three primary causes of bunions,
which we will cover first, and then follow that up with a five-step plan to overcome
these issues. The first and probably the greatest cause
of bunions is wearing shoes that have a narrow toe box. You see, our toes are made to be independent
of one another, for the simple reason that they spread or splay apart to grip the ground
and increase our base of support during load-bearing tasks. After all, the feet have to balance and support
our tall, upright bodies. Therefore, having the ability to increase
one’s base of support through toe spread is an obvious characteristic we should try
to preserve. Well, unfortunately the rounded, narrow and
pointy toe box design of modern footwear does not accommodate this natural toe movement. While this design might be desirable for the
fashion runway, it is not good for our feet. These pointy toe boxes squeeze our poor toes
together and prevent the natural spread or splay from occurring. The great toe, being pressed up against the
edge of the shoe, experiences the brunt of this non-ergonomic design. Over time, the big toe will actually start
to conform to the shape of the shoe. This is how the misalignment of the big toe,
known as “hallux valgus” or “bunions,” actually begins. This makes sense when you consider how incredibly
adaptable our bodies are. When we break a bone, for example, a cast
is used to force the bone to grow back in proper alignment. Similarly, we can see how, due to certain
ancient traditions in Africa and China, external accessories have been used to purposely manipulate
the foot and neck shape. Well, our modern footwear is no different. If we spend enough time in modern shoes, our
feet will conform to their shape. Moving on, the next cause of bunions is poor
ankle mobility, particularly in dorsiflexion, that is, drawing your toes back toward your
shins. You see, when we walk and get into the terminal
stance phase of the gait cycle, just before our foot lifts off the ground, the ankle of
the back leg dorsiflexes or bends forward. This is really important because this position
enables us to take longer strides; otherwise, we would just shuffle around, which not only
looks weird but is also extremely inefficient. Now, when our ankles are tight our brain hunts
for extra range of motion around this area, in an attempt to remain efficient. The default compensation is to use the arch
as a second ankle by spinning the foot out, pronating and collapsing the foot arch. In this way, we can artificially claim back
the lost range of motion in the ankle joint and keep our stride length normal. But there are obvious side effects to this. I won’t mention them all in this video. We'll focus only on what happens in the toe
area. Check what happens to the big toe when this
duck-footed walking pattern is activated. Every step places extreme side loading onto
the toes, instead of the natural flexing we see when the feet are pointed straight. It’s this side loading that places valgus
or bunion strain on the big toe. Alright, so the last major cause of bunions
is flat feet, particularly acquired flat feet, which is also known as “fallen arches.” I won't go too deeply into the topic of flat
feet because we have posted content specifically on this subject in the past, which you can
find linked in the description below. But with regard to understanding the connection
between fallen arches and bunions, we need to look at how our weight is distributed over
the feet in these different shapes: When the arch is prominent and raised up,
the weight is distributed along the outside of the foot in a convex shape, as can be seen
in these foot prints. This loading pattern keeps the big toes pushed
towards each other, helping us to maintain correct alignment from the mid-foot to the
tip of the toes. However, when the arch collapses, the weight
distribution shifts onto the inside of the feet and changes to a concave-shaped pattern. In this way, the big toes are loaded in a
way that pushes them apart from each other into that misaligned bunion shape known as
“hallux valgus.” Okay, now that we have covered the three main
causes of bunions, let's dive into the five-step plan to resolve these issues and, hopefully,
improve the alignment of our feet. The first step is to select shoes with a wide
enough toe box to accommodate the width of your forefoot and toes. If you have followed this channel for a while,
you'll know that we are strong advocates of barefoot shoes. Basically, barefoot shoes are designed to
protect the feet from the elements without changing our posture or blocking the sensory
input we receive from the ground. If you want to learn more about barefoot shoes,
then be sure to check out all our reviews linked below, particularly the video in which
we cut open a pair of barefoot shoes and compare them to a pair of popular, cushioned running
shoes. Anyway, one of the features that all well-designed
barefoot shoes have is a wide toe box that can accommodate the natural toe spread or
splay that I described earlier. An easy way to see if your shoes have enough
room in the forefoot is to flip one of them over and place your foot on top of the under
sole. A toe box of sufficient width should comfortably
fit all your toes and have a bit of extra room to accommodate the spread that occurs
naturally during weight bearing. To double check, one can also pull out the
inner sole of the shoe and check the toe box width in that way. In either test, if any of the toes spread
out past the outside edges of the soles, as can be seen in this pair I am testing, then
it is a clear indication that your toes will be forced together and out of proper alignment,
causing the hallux valgus shape we are trying to avoid. So, in summary the first step to improving
the alignment of our toes and avoiding unnecessary bunion strain is to select shoes that are
wide enough in the front to accommodate our toes and their spread during walking. Check out all the shoes that my team and I
personally use and recommend linked down below in the description. Furthermore, because footwear is so important,
I am thinking I should maybe seek out the absolute best shoes for bunions. Let me know down in the comments if that is
a video you would like to see. And once we have made it, I’ll pin a link
to it in the comments too. Okay, moving on. The next step to this five-part plan is to
use silicone toe spreaders. These small and flexible silicon accessories
fit between your toes to help separate them from one another. This can be very helpful to push the big toe
back into alignment, which is the goal we are trying to achieve here. A study conducted in 2017 on 90 people with
moderate to severe bunions proved the effectiveness of silicone toe spreaders for bunion correction. The participants were split into two groups
of 45 people each. Both the control and experimental groups were
given unrestricted shoes with a wide toe box and flat soles. However, the experimental group were also
provided with silicone toe spreaders to use every evening for a few hours. After 12 months, the group that used silicone
toe spreaders in conjunction with the correct footwear showed a significantly greater improvement
than the group that only changed their shoes. So, the silicone toe spreaders worked great. In fact, it was found that the average bunion
angle in the control group that only changed their shoes actually worsened. So, what this secondary finding shows us is
that once we have developed a bunion and lost the natural alignment of the great toe, even
if we wear the correct shoes that have the wide toe box, there is no guarantee that the
toes will spread to fill that larger space. It's almost like they have been trained to
be together and we actually have to nudge them apart with these gel spacers to teach
them how to spread out properly to fill the wider shoes. But we can take this further by also looking
at the socks that we wear, which is the next step in this plan. Socks, like most shoe designs, have a narrow
and rounded shape in the front. This is unlike our foot, which is naturally
straight along the medial side and rounds out only gradually on the lateral side. Sock designers also take for granted the separation
of the toes. So, again you are faced with the issues described
in the footwear section of this video, whereby the narrow forefoot squeezes all the toes
together and prevents them from moving independently of one another. To show you just how natural it is to have
the freedom to spread and wiggle your toes, here is a clip of my newborn unconsciously
moving her toes continuously while chilling on my lap. I've been fascinated to see how her feet are
developing, and I plan to do content on child foot development in the future, so subscribe
to not miss out on those videos. So, to overcome this issue you can buy socks
that have compartments for each toe. At first, I found it weird to feel material
between all my toes, but I have since gotten used to them and actually quite like the feeling
now. Obviously, having the ability to freely move
the toes is a great sensation too. Anyways, continuing with this multi-factor
approach to fixing bunions, let's move on to the next step, in which the focus is on
ankle mobility. As explained earlier, tight ankles promote
a toed-out walking pattern, which causes the foot arch to collapse inwards and pronate,
placing a lot of bunion strain on the big toes. In order to improve the ankle's ability to
dorsiflex during walking, the best thing to do is to spend time practicing in the position
of restriction. In this case, I’m talking about the part
of the gait cycle just before the back leg starts to lift from the ground to push off. So, I’ll exaggerate this position by taking
a longer step forward, while still maintaining the back heel on the ground. If you have tight ankles, you will feel like
the back foot wants to spin out. Avoid this by focusing on trying to keep the
foot pointed straight. Pressing your toes into the ground will also
help stabilize the arch to maximize the mobility through the ankle joint rather than in the
foot, which is our intent here. Then, with the back leg extended, slowly bend
the front leg forward into a partial lunge. If you keep the back heel on the ground, you
will feel a nice stretch all the way up the back of the leg. This is a sign that you are doing it correctly. We cover ankle mobility in much greater detail
in our online programs. We show you how to test to see if you have
asymmetries between your legs and how to overcome those imbalances. We also include a variety of mobility drills
to attack any kind of restriction in this area. Links to our programs are in the description
below, together with everything else mentioned in this video, such as the silicone toes spreaders
and toe socks. Okay, now on to the fifth and final step to
fix bunions. This final stage involves building up the
foot arch through foot-strengthening exercises. What I will show you in this video is probably
our most primitive foot exercise, which can be practiced anywhere. It involves simply spreading out the toes
as far apart from one another as possible, and then contracting them together with a
good amount of effort. This is the exercise that newborn babies unconsciously
use to build up their foot strength before crawling and walking. Here is a short clip of my one month old practicing
her foot exercises. It has been incredible to witness just how
wide she can spread her toes and with such control. This action is unconscious for her, which
tells me that performing this move is an aspect of the innate intelligence we are all born
with. Furthermore, this exercise acts as a sort
of litmus test to see whether you have control over your toes and are able to spread them
wide apart. I've found that many of us struggle to move
the toes in this way. This is due to years of our feet being confined
by the modern shoe design, which prevents independent toe movement. It’s a simple case of use it or lose it. We see the same thing in one’s ability to
deep squat throughout one’s life. So, while relaxing at home, barefoot on the
sofa, use this simple toe spreading and squeezing exercise to slowly regain mobility, strength
and control of your foot arch and toes. This is an exercise that is totally safe to
do often, because we are not loading the tissue with any weight. Once you have a good grasp of this exercise,
be sure to check out our Strong Feet, Strong Foundation Program, which includes all the
foot-strengthening exercises and tools you need for building your athleticism from the
ground up. Well, that concludes our five-step plan to
fix bunions. There is just one more piece of info I would
like to add. If a bunion has progressed to the point that
arthritis has developed in that area, due to the chronic inflammation that is usually
present with severe bunions, then some of these methods, such as the use of silicone
toe spreaders, might not be suitable. In these extreme cases, it's best to seek
out a good podiatrist to help you out. Personally, I’m fond of the professionals
who don't just myopically throw an orthotic or surgical blade at every problem. Rather, I would seek out a specialist who
is well read in all forms of treatment (both invasive and non-invasive) and is determined
to help you identify and resolve the root cause of your problem. One such example is world-renowned podiatrist
Dr. Emily Splichal. We did a super interesting podcast with her
on foot health and performance, which I'll also link down below in the description. Well, that concludes this video. If you found the information useful, please
do hit the like button because it helps extend the video's reach. Also, subscribe and ring that notification
bell to get alerted when we make new videos. Until then, cheers!
