Bunions! What causes them?

so come on then tell us about bunions what are they and why do we get there?
 okay why do we get them okay so there's loads and loads of sort of differing information out there about bunions the causes of bunions and how we can prevent them there's a lot of misinformation out there as cotton is away with with the internet and there's also a lot of confusion amongst the professionals as to what causes bunions again that's that's not uncommon with any azar sort of areas that we working with any particular injury but we do know one thing we know lasers for the two to four percent incidence in the general population we know that unfortunately women are 90 percent of the population and it's a real problem in the female population we know that it generally comes around in sort of 30 to 50 year age bracket although there is a high instance in the juvenile population so there is quite a high end there is yeah but we tend to see the results of that early deformity in their muscular skeletal maturity when Isis would hit 18 to 21 years old and we start to see more results as they get AB elder and certainly the painful aspect which is what most people will present the clinic with that doesn't tend to pretend until you're a little bit older okay that's not undressing through with a lot of the juvenile Halleck seductive Elvises getting concerned for it but then there's quite often underlying inflammatory conditions for the juvenile arthritis etc...

so do is it true that that shoes can cause it?
absolutely yeah the way it does have a large implication and now my screams come back on ah I'm just going to pull up a little picture so as you can see here the classic sort of picture and probably the the most common finger is pointed at Footwear is the high-heeled sort of footwear with very tight narrow toe box and what that does is as we can see here it causes a change in the direction of the big toe and essentially what it does because you might flip them right yeah yeah well it does it squeezes the toes like so and a bunion basically is a deviation of the toe at this point here and that happy that goes laterally and then there's a middle deviation of this metatarsal bone here so you've got them acting on two different directions so you can see how that the shoe here is causing that squeeze and starting the first of the problems they're just going to take you onto to another picture which is that one there so as you can see here we've got that lateral deviation of the big toe okay so you like okay it's not quite clear that one not quite clear let me find a better one then go for that one yeah that's better that's better okay so we've got that lateral deviation it's going away from the center line the body of the big toe itself and then the metatarsal

bone which is this bone here goes immediately and then you get that classic sort of alt dropping heroes of that medium and there that's the bit that causes most of the pain and that's what rubs on your shoes and that sort is really the fundamental part of the pain process in this picture so yeah sorry card so a lot of research would suggest there's extra bone growth around here okay yeah now verdicts a little bit out on that is some some papers say that there is extra bone growth some papers say there isn't but certainly this sticking out to the side does cause trauma to that bone there from Yin particularly from Footwear but there is sometimes a little bit of extra bone growth around that area there according to some of the papers and I guess it's like with other things I mean I've seen loads of bunions as well and they all look slightly different so it's safe to say that some people may happen and others won't necessarily absolutely yeah I mean there's different staging of bunions and that you aren't going to in too much detail but basically the more deviation you have a big toe the higher the grade of the bunion okay yeah and the problem with that is not only did it affect the big total of what we come the first way which is your big toe all the way down to the mid foot here as it starts to deviate and encroach on the other toes these ends start to retract and claw then you get problems with the backs of the toes rubbing on footwear and also it changes the mechanics and the feet quite considerably and the resulting change mechanics and loads extra weight through the lesser toes over the metatarsal heads here which is a lovely bit so if you picked your hand up marika the nasty bits under there which represents that the metatarsal phalangeal joint here okay if we lift this if you look at the big toe you can see it's got a lovely big surface area here it's nice and wide and it's designed to take load we look at these little chaps you can see they're probably a half or even a third of the size of the surface area the hallux there and so therefore you start to get hard skin build-up underneath that area of the forefoot and that brings a lot of people to Clinic because of that pain particularly the area there and that essentially happens is because as we come up and over we then start to twist either because it's painful to load through that toe for because that toe doesn't work quite as effectively as it once did so it doesn't Bend quite as well again the research is kind of differing in that some people say it bends absolutely fine other people say it doesn't but certainly there is a trend where people then twist off as opposed to coming off nice and squarely like so and you also
get a lot of people thought in pain over the medial aspect of the bunion here and in some cases you also get sort of near itis and irritation of the nerves it passes over the back of the joint here and that can be quite uncomfortable as well like a burning sensation down into a big toe and I'm just going to cut up my so my mum has been preaching at me since forever the first moment that I can remember about shoes not to wear narrow shoes not yeah and I mean I was given the biggest feet ever on a female so I can't fit my feet into normal female shoes so I've always worn trainers or white shoes but I'm definitely starting to get bunions so what what would be the cause for that what could it possible always be most bunions are hereditary I mean there's other causes a long big toe is another cause tight hamstrings and tight gastric sand Solaris or 20 kilos tendon that has been cited as a cause again the research doesn't necessarily agree with that and near a dynamic changes so changes in the way that the muscles are firing underneath the toes and increased big toe sort of movement so increased first Rea mobility so hyper mobile feet is another instance of it there's certainly many many different ways even am taking the second toe or a short second toe can lead to bunion formation as well most of it is hereditary as your mum or dad had bunions it tends to go down the female side that if your mum or dad has bunions and then there's a good chance that you could inherit that and they tend to be bilateral as well just to compare on the mid agree I think I'm probably going to fall into the
hypermobile feet then that that's going to be there yes for mine yeah so if you're saying they have read the Tori which I can't say that word is there anything we can do about them okay so the only way to get rid of a bunion effectively is surgery oh no that is only way to get rid of a bunion okay okay now the in the half an hour slot that we've got I could use three of those slots just talking about surgery so we always delve into it in too much detail I need to say that Paula Radcliffe suffered his bunions for a very very long time she changed her running gait to offload the painful bunion so she has changed a whole way of running to accommodate that pain yet and and then after she ended her career she had the bunion surgery and she said this was a quote from a article she different Daily Mail she said that she wished she'd had it done years ago oh wow okay and she still runs obviously not the same they've all but she still runs to a degree now I think possibly I would err on the side of caution with any surgery and I'd always try and exhaust the conservative methods first the conservative methods are really only aimed at pain reduction or cessation they are not going to improve the position of that type there's many many different ways conservatively of addressing that so I'm just going to take you through a couple of the sort of common ones and again my my powders so if you give up and then take you out of this program so I think you asked me about toast once yes that was one of the questions that came in I remember okay I bought some years ago but yeah did it work well yeah absolutely yeah and it irritates the tips of your toes and the thick clothes as well or if you're laying in front because it's the mattress and they're not the most comfortable thing as you well know
and they are live with the fashion killer this is kind of like the classic traditional one that you'll see out there there are so many different types out there this one here is a little bit more of the Robocop version little bit more expensive and but all of them are aimed at restoring the position of that because I think the angle of the screen or something is just doing a white thing no somehow is just showing up as a white screen okay it's it's not a very interesting slide to be on whose birthday is to give an idea of the splits afterwards in there in the comments things I can't think yeah perfect yeah that'd be great I fought against you and P those ones America no can't see any of them I don't know what's going on with a screen Elin alright was to correct that screaming because that not working I think it gives to white on a white background yeah but there's so you can get silicon wedges that go in between the toes okay again they're aiming just right in the toe l and that can reduce the kind of stretch forces on the joint capsule which is predominately what caused a lot of the pain so there's those sorry just to take you a step back do they actually work then I help reduce pain but they don't they don't give you any lasting effective stress and would you if somebody was in a lot of pain would they wear them just at rest or would they wear them during the day as well some people wear them during the day as well okay a lot of a lot of runners actually used a taping technique along the inside of the arch and the big toe that again pulls a big toe back into alignment and they report that quite an effective way of reducing symptoms and I think what I do Reiko just go through the anatomy that we're dealing with to give you an idea of why this stuff doesn't really work

yeah so can you see that all right working yeah okay this is underneath that threatens go take the first layer away so this white structure here this is your classic sort of plantar fascia okay so large structure I would liken it to a cross between elastic band in a spring very powerful okay let's take that away we're then going to look at this in the muscle here okay and this is flexor hallucis brevis okay so hallucis is the flash term for the big toe okay so this is the muscle the short muscle that flexes the big toe downwards okay again very powerful muscle and takes a lot of force to alter it's sort of mode of action in its trajectory it's pudding okay the big one and with the big toe and is this chap here and cool might come up and he plays a huge role in the formation of a bunion so this is we flexor hallucis it's like extensive so he loses all the toe upwards so it causes big toe up in here like that so if I had to show it where that is on my own foot then that kind of runs along the front this bit isn't it that's right yeah so it runs if this is here's your foot you can probably you can probably see my extensor hallucis sticking up okay yeah and that comes all the way up there yes yes all right now all the time it's pulling in a nice square fashion down here is going to be locking this joint into position however at Cody BH around the corner as you can see it insert into the tip of the toe up P yes okay as if deviates around the corner it then acts like a bowstring and starts to pull this around the corner yeah it's dead lastly a very very strong muscle okay very long length of muscle as well so trying to counter at that is very very difficult okay well then bring you on to this chap here and again I will show you just how much force you're acting against to try and correct this problem and it is abductor hallucis so this pulls your big toe in okay towards the midline of you but yeah okay any sort of Paso mechanics that the reason that this problem is caused this has a
large part in cooling this out of alignment in combination with displacement of the little bones here it says modes so these two of the bones that sit underneath the big toe they sit in one of the very small muscles so you get pulled out position and once they pulled out position they then start to act in a manner that contributes to further deformity at that time okay trying to capture is very very difficult a huge strength working up against and you're using muscles and now in a slightly mechanically disadvantaged position to try and counteract it so other sort of papers and a lot of people advocate toe strengthening and stuff like that and that's true that it can help certainly help with pain that will it give you absolute correction of the toe very very unlikely if at all I've never seen it work but it does work brilliantly for and hang on the joint capsular medial paying that nasty really bringing so interesting I wonder if in people who don't get bunions is it that their ligaments are keeping that toe in the perfect alignment and do you think it's in the rest of us maybe the ligaments fail so there's that if we if we go down right down to your seus level right down to the bones the shape of the phalanx here shape at the head of this of the metatarsal head here that can have an effect like this can be different in shape so it can be a quite a pink so the joint here which leads to more joint instability and there's loads of different variations that says modes can change position and you can have a media deviated says more as a result of congenital sort of problems if we go to skinny toward everywhere you could have a neuro deficit where one of the muscles is working quite nicely on one side and on the contractor side it isn't working as well so then you get that deviation occurring but where there's so many different factors both intrinsic and extrinsic that the sort of approach to this has to be multilateral trying improves the position the only way to truly correct the bunion is through surgery what would they do when they go and do surgery do they fix the the toes together or the bones together or what would they do normally again really long wing because there's a bell anyway just kidding that particular can effectively depend on which one they do they'll cut this bone in half through its longitudinal section here okay now slowly eat the bone back into fishing and lop off the extra bit of bone there's no wires and they can screw it together 15 percent recurrence rate of the deformity okay so it's not a complete answer it's bloody painful and you can be laid off and running for a while you know and it's a bit like knee replacements Maury because they either go really well or they're you know problematic sore there's a picture post surgery our advice would be the same as with a knee replacement that you wait until you really can't bear the discomfort yet what we haven't covered yet and I sort of leave it to a bit further into the conversation ease
the role that pronation or flatfeet has in the formation of bunions and now it's as simple as that it doesn't have any effect on the formation of counterintuitive for me because I would feel as if the foot does that more often then it's gonna cause it to turn that way exactly that's what we used to think research shows is actually that that's not the case and in fact the pronation tends to come after the bunny in this forms okay because the big toe is not there to keep nice and stable then you've got it yeah you got it and then because of that sudden pronation that occurs now we're going to say as well pricing gets a bad rap we need pronation okay so it's costing the villain of the piece but it's really not and we do need pronation in this particular instance pronation at the the timing of the predations was the late part of the as we come through the contact side of the gate psyche that can really cause a stretch in the joint capsule and that's where particularly running when you've got greater forces acting assured sure the time span because you've got much less time on the ground and that coming that can really cause discomfort and pain thank you for watching if you would like to learn more about preventing sports injuries make sure you hit the subscribe button see you next time  "