Biomechanist Katy Bowman and biologist Jeannette Loram discuss bunions; what they are, how they are created and what to do about them.
Inspired by a recent article in National Geographic, they unpack the idea that bunions are a failure of evolution. Rather than being due to a poorly engineered toe, Katy and Jeannette show how bunions are actually created by forces of habit: restrictive footwear and certain walking patterns create forces that push and pull on our big toe and foot with every step we take. Find out how you need to look to the hip, as well as the foot when working and walking to correct bunions.
OVERVIEW
(time codes are approximate)
00:05:15 - National Geographic Article on Bunions (Jump to section)
00:15:15 - Bunion vs Hallux Valgus and Primitive Ape Feet (Jump to section)
00:20:20 - Tailor’s Bunion and Folded Fin (Jump to section)
00:22:30 - What You Can Do About a Bunion (Jump to section)
00:30:30 - Gait, Toe extension, and Hips (Jump to section)
00:34:48 - A Movement Break! (Jump to section)
00:36:15 - Surgery. (Jump to section)
00:41:39 - Other Things Before Footwear Changes (Jump to section)
LINKS AND RESOURCES MENTIONED IN THE SHOW
PODCAST TRANSCRIPT
(Theme Music)
KATY: This is the Move Your DNA podcast where movement science meets your everyday life. I'm Katy Bowman, biomechanist, author, and I can lift just my big toes while keeping all the other toes down. Can you? Everybody is welcome here. Let's get started.
(music fades)
Hello everybody! Welcome to this episode. I'm very excited to make a quick announcement before we get started. And that is Move Your DNA is getting a co-host. And that co-host - you have been hearing from her in the last few episodes - Jeannette, Loram, biologist...
KATY: Would you be my co-host?
JEANNETTE: I would love to. It's an honor and a new adventure, at least for me.
KATY: I love having a cohost. I really miss the Dani days of the podcast. And it's just more fun, I think, to chat with people.
JEANNETTE: I'm really, excited. We chat a lot off-camera and yeah, it's going to be fun.
KATY: Yeah. I think the tricky thing is going to be to keep the episode lengths short. Right cause we can definitely ... what do they say? I was going to say wax on. Is there a more British way of saying ...
JEANNETTE: My husband would probably say drone on.
KATY: Oh, right.
JEANNETTE: But I'm trying to think of a more positive...
KATY: How about crone on? Since we're crones.
JEANNETTE: Yeah.. Maybe
KATY: We're going to crone on.
JEANNETTE: We're going to, yeah, that's it. Perfect.
KATY: I think that's better. Yeah. Crone just feels more like... I don't know.
JEANNETTE: It's yeah, it's where we're headed.
KATY: It's in the direction we're going. We might as well talk about it on our way there. Okay. So today we're going to talk about bunions. I know. I feel like in any other podcast, this would be the not-exciting episode. It's like, it's the bottom of the barrel for me. It's a peak. It's a peak to get here. And I just got back from North Carolina where I was leading a three-day foot mechanics retreat: foot exercise, foot health. Healing your soul is what we called it. And it was quite fun.
JEANNETTE: There must have been lots of bunion chat, I imagine.
KATY: I mean, yes. There was lots of bunion chat. And bunion chat is tricky to do when you don't have the foot right in front of you where you can be moving and pointing to things. It's what makes it tricky to write about. And we're going to try to talk about it, recognizing that people listening are going to have to work kind of hard to imagine the shapes we're explaining. Because even when I had people unshod and could be right next to them to show them sort of the movements I was talking about that created height, let's say, to the foot. Three-dimensional modeling, I find, is very challenging for folks to grasp. It's not easy when there are three planes of motion you have to consider all at the same time.
JEANNETTE: Hmm. Yeah. Agreed.
KATY: And Bunions requires that.
JEANNETTE: Mm-Hmm.
KATY: I kept saying, "I would love someone ..." Who creates origami? I mean, I know origami, is an ancient paper art, but surely there's someone out there who's trying to figure out if they can create a new animal shape by folding the paper a different way. I would like a foot. I would like an origami foot.
JEANNETTE: An origami foot.
KATY: Yes, because so much of - if you've ever done origami, you start with something flat, and you're folding it. And then through special folds - I don't really even know what it is - through special folds, you're able to then, all of a sudden create a three-dimensional object from a two-dimensional piece of paper and the foot is very much like that. So there's this way of creating height in the foot by starting with this, you know, sort of what we think of as a flat object. I don't know if I'm gonna be able to create that in a pot. Well, I'm not gonna be able to do the origami. I'm just hopeful if I can create the image in people's minds as they're listening right now that will help them understand.
JEANNETTE: I definitely felt one reading about bunions that actually me standing in front of a mirror and actually trying to push the feet into the directions we're talking about is helpful. So maybe listeners could actually try or film themselves to look at that foot when we're talking about things.
KATY: Right, and then will just remember as we're talking to go, go to the mirror. This would be a good time to go to the mirror. I mean, if you're out on a walk, stay on your walk, but when you go back home, try this in front of a mirror.
KATY: So the reason I wanted to do this episode is there was an article in the National Geographic. By the time you're listening to this, it's been about a month. But I got a lot of people forwarding me this article because the article title was, do you have it in front of you?
JEANNETTE: I do. Why Do We Have Bunions? Blame an Evolutionary Toe Failure.
KATY: Oh, yes, always with the blame.
JEANNETTE: Yes, always with the blame. And I feel like ... I bristle straight away.
KATY: Yeah.
JEANNETTE: You know, "We're badly designed." That's always the blame. And we should say that this article is behind a paywall.
KATY: Right.
JEANNETTE: So if you don't have access... I mean, we can try and explain what the article says, but when you get into the article, that's not really the meat of the article. Which I found fascinating. And I do wonder whether there's somebody who writes the article and then there's another person who picks out an edgy - an inflammatory clickbait
KATY: Of course, absolutely.
JEANNETTE: And there we are.
KATY: Yeah, as someone who writes sometimes articles for larger publications - this is sort of behind the scenes and it's not necessarily relative to the foot. But I think it's helpful to recognize when you see articles like this. I will write a full article and they'll say, "Suggest a headline". But now AI is really good at picking keywords. And you're usually wanting content to be framed in a way that would sort of incite indignance, you know. And, then to get people to do what they did with this particular article. And I'm not sure if they've recognized that there are certain communities that are likely to spread a particular article. But for sure the person writing the article did not write the headline, because it's always tinkered with. Even my articles that I submit are tinkered with to try to get this language, these keywords, you know, in them.
JEANNETTE: Right.
KATY: And so anyway, another reason I wanted to do this podcast was because I figured a lot of people that I could see discussing the article probably didn't read it. Because, again, it was behind a paywall and so I thought we could sort of go through the article and then just have a general discussion about bunions, but through the lens of the article. Because I think that the article is the conversation starter and we'll just set the headline away because once again, that's not really what the article was saying at all. And the article was really circulated in the minimal footwear community. You know, the minimal footwear online community, the foot, natural foot movement - the foot health of spaces. People who are all about the feet and are trying to spread messaging about... the state of your feet is, I think in the footwear community, it's very much being created by the shoes that you are wearing. I try to talk about a gait and your full movement diet as what's going on in your feet. It is not as simple as the shoes that you're wearing. It has a lot to do with what you do with your whole body all the time. It's not just toe-spreading. But yeah, so I have the article in front of me. We're not gonna read it verbatim. But I'll just read the top line: "People for millennia have suffered from the painful foot deformity, (and they mean the bunion), that may be the result of a uniquely human toe. Here's why and what you can do to ease the pain." So it seems like I always try to read ... this is also helpful; How do I read articles? How do you read articles? I always start with what's the intention of the article? So it seems like the intention of the article is what to do about foot pain that's caused by a bunion. I mean, at least that's stated at the beginning.
JEANNETTE: Mm-hmm.
KATY: Did you pick a different one?
JEANNETTE: Yeah, I, well, I was a bit confused, I'll be honest. Because they sort of say, well, people for millennia have suffered from this deformity. Here's why. But then, they really state, the thing still perplexes scientists. So I think they don't resolve that at all. They just kind of throw some ideas, but they don't really resolve it. And then, yeah, and I think you're right. The end of the article is much more about what you can do. And I think you're probably right that that's what they were trying to get to in the end.
KATY: Well, I guess the overall point of the article is to get to the website. I mean let's just call a spade a spade. So when articles often don't make sense, it's like, "Did you get to the website?" Then that need was met. But I assume also, I would, you know, be gracious enough to think that when someone wrote it, that they were interested in this idea. So, just now we're gonna step out of the article, but also use the article as ... not a template, but as a trail guide, I guess, for this conversation. I want to start with how they defined a bunion because I think that if you're listening, what's a bunion? So they have a line also known as Hallux Valgus: bunions are dot, dot, dot. And I just had to stop right there. Because I taught sort of this biomechanical training for movement teachers for a long time. And one of the questions on the test was, "What is Hallux Valgas?" Specifically to differentiate. Hallux Valgus from a bunion. because Hallux Valgus - Hallux is the great toe, the big toe, and Valgus is a direction. So it's just a joint position. Hallux Valgus is a joint position. And that's when the big toes are, let's just say angled in the direction of the pinky toe. That's sort of what you see. And then this is where you have to work with me in visualizing shape. All of your toes have their own bones. But inside the foot, there's like a bone for every toe - a long bone for every toe. Your first metatarsal. And when you have Hallux Valgus - when the big toe points towards the pinky toe on the left side, that longer bone inside the foot that would normally be in line with the big toe, it sort of buckles in the opposite or it deviates in the other direction. So you get sort of a small corner on the outside of your foot. So it's not just that you've got this one toe sort of angled off to the side. The bone in front of that toe also kind of goes off in the opposite direction. So you've got this sideways protrusion. And just the great toe is technically Hallux Valgus, but what creates a bunion is both of those things happening. And then when you combine those two things, the pressure of that new protrusion interacting with the ground or the friction that's caused in that area from this joint configuration starts to grow new bone. There's inflammation and very similar to a bone spur. It doesn't have a spur shape, but it's the same mechanism. It's the same type of bony growth. Bony growth that grows because of excessive rubbing pressure, pushing, pulling, however, you want to think about it. And that is more what the bunion is. It's the development from that joint position. So I think keeping them separate is helpful. Because you can straighten a big toe, but you still have this bony growth to contend with.
JEANNETTE: Right.
KATY: And then the bony growth starts to create further buckling of that area. Right? It's a mass unto itself now. And we all have bunions in different states. So you can have a bunion that the growth is quite large. Or you have just the deviation right now and no growth at all. And I wouldn't consider that necessarily a bunion.
JEANNETTE: Okay. That's interesting. Because some articles say the metatarsal head is because of this position of being pushed medially is the bunion. And then on top, you can get a bigger bunion with the growth of the bone.
KATY: Yeah, it's, it's just one of those things of where do you want to call it? So my big thing is I like to keep the position separate from the problem.
JEANNETTE: Right.
KATY: You know, or the painful bit. Because what's the problem with a bunion? You know, that it's something that I think changes for a person over time because a bunion doesn't show up overnight. You know what I mean? It's something that's happening and, deepening- is that the right word? Progressing is probably a better word. It's progressing slowly. And, I have seen severe Hallux Valgus without a real significant protrusion. I mean I could see what someone would call a bunion. Right? Because it is the metatarsal head. It's round, it's there. But it's different than when you have the growth.
JEANNETTE: And that's possibly where the gate patterns come in. Right? You could have…
KATY: Well, I think the gait pattern ...
JEANNETTE: Well, that's part of what creates the valgus.
KATY: Yes. Right. That the gait pattern itself is part of what's pushing the big toe out of the way.
JEANNETTE: Right.
KATY: But then what happens is once you get a formation in that area, now you have that formation informing your gait. So it becomes a cycle. And I think that's where we are oftentimes in younger and middle age. The things we're doing that are shaping us in the future are just sort of benign. Like, it's just not a big deal. And it's why it's so tricky to work on something that's not causing you a problem right now.
KATY: But over time the big toe is so important for gait. This extension of the big toe, when it deviates laterally as it does with Hallux Valgus, as it does when you have a bunion, you're not able to really push off. We would look for points of a foot moving through when you're taking a walk and you will not see those. Because the foot is sort of be pushed out of the side. And then you can also develop Hallux Rigidus, which is a stiffness where you don't get extension at all. And then walking becomes painful.
JEANNETTE: So, we've got the shape and we've got the bunion. How do those things happen in the first place would be the next question. This is the way I work through it in my mind. If you have a toe bone, a metatarsal bone that's deviating. It either has to have been pulled into that position or pushed. Like it's, something's pulling or pushing it into that position. So this is where the title I think comes in. Because this is when they do talk to the evolutionary creation of the human foot. And I think this idea has been around for a while. It's almost this return to a primitive ape foot.
KATY: Who is saying return to a primitive ape foot?
JEANNETTE: Oh it was written in a paper ages ago. But if you look at the paper, which was in 2000 something. I'm just looking at my notes here. It was a 2017 paper that they extracted this little nugget of information
KATY: Oh, just, the, the one sheet sort of like a position, a position paper, sort of, you know.
JEANNETTE: Right. And they compared the feet of chimpanzees, gorillas, and humans. And obviously, apes had a grasping foot. And like everything in the human body, we come from an ape structure. And what the authors were essentially saying is, through time, the foot of an ape, our ape ancestor, has been rejigged to make the human foot, which is different because we vault over that big toe. It's stiff and we bolt over that toe.
KATY: Right. And we don't grasp. To me, I feel like it was saying we're not climbing in trees. We're not wrapping it around basically ...
JEANNETTE: Right, so rather than having a ...
KATY: A thumb...
JEANNETTE: a big toe like a thumb, yeah.
KATY: Right.
JEANNETTE: We have one that's flat. But they're saying we still have these slightly oblique pulls from some of the muscles. So really what they're just saying is because those slightly oblique pulls, if things get out of balance, which they have no, there's no information of what, what that imbalance might be.
KATY: High stress. They just say high, like a high, stress, or a push or pull. A big push or pull.
JEANNETTE: Push or pull. And the pull could start pulling because those muscles are aligned slightly obliquely they could start to pull. So that's kind of what the Nat Geo article has taken and said, "Right. You've got this kind of poor engineering in your toe because it was from an old ape structure. But there's no, in the entire Nat Geo article, there's no reference to a push. There's no reference to how you walk and how the toe might deviate - apart from saying that we walk on very hard ground
KATY: And, and then shoes, I mean, I, so that thing, the thing that was in the article, which if everyone in the footwear community who were kind of upset about the article would have seen is like, I feel like they did pretty well represent that a push from the outside of the shoe, you know, would be something that could create it.
JEANNETTE: Yes.
KATY: So if you read that article and you were concerned that footwear was not represented as we'll say, a cause of bunions, I feel it was.
JEANNETTE: It was. Yeah. And they talk about the really interesting study in, Cambridge, the archaeological study, which just very briefly, they looked at different populations in cemeteries in Cambridge from, I think it was the I want to say the 10th to the 14th century. And they saw this big increase in bunions when there was a transition to these very pointed medieval shoes.,
KATY: Yes, right, that fashion trend.
JEANNETTE: That fashion. And they could really link it to that fashion. And it more occurred in wealthier as well. So people that would have worn those kind of fashionable shoes. So that was nice.
KATY: Yeah, and also in the the beginning of the article, I thought they used ancient footprints as a way to sort of like to support "bunions have been around forever. Because here are these footprints of, you know, someone walking across a plain that got fused in mud." And you could see that they had a bunion. But, if you go back and you check the sources of where people are pulling bits of information. And. If you read - they didn't link it, but we were able to find it. It was talking about a tailor's bunion, which is, which is not what the article was about at all.
KATY: So That's a tailor's bunion is on the pinky toe side of the foot developing a little bump on the outside edge, just around the, usually, fifth metatarsal head. So it's again, those. It's just below the pinky toe and on the outside of the foot. And it's named Tailor's Bunions because if you were a tailor sitting and sewing cross-legged on the ground, that the outsides of your feet would be pressing against the ground. And that pressure would cause this thing to develop. So anyway, I just thought that - it's a bunionette. I just thought it was very funny that they're using a piece of information to support their overall argument. But this is the problem with skimming for keywords and saying, "Ancient foot has bunion" and then not reading it
JEANNETTE: And they were trying to make the point it was this eternal ailment, but they had one data point, but...
KATY: Yeah.
JEANNETTE: But yeah, so that was interesting. And actually, if you look in a lot of the more robust sort of review articles, you actually find that there's not a lot of ancient footprints with bunions. And it's much more common in shod populations than barefoot populations. And there's quite a lot of information out there to show that.
KATY: It kind of reminded me of folded fin…
JEANNETTE: Very much.
KATY: …in Move Your DNA, you know. Where it's like if you look at almost all of the whales in the - orcas in the wild, their dorsal fin will look this certain way, unless there's been some sort of trauma. But every single one in captivity has it this particular way. And rather than looking for the one folded fin from a trauma in the wild and say, "See!" This is just a natural thing that could happen.
JEANNETTE: Yeah, that's exactly what I thought.
KATY: That's what, when I was reading it and I was like, okay, it's a stretch, but I see that you have your data point. It is a stretch.
KATY: Okay. The rest of the article seems to be what you can do about a bunion, which obviously I feel like many people would be interested in. And I do feel like talking about what you can do about it and where the push and pull are made.
JEANNETTE: Mm-hmm.
KATY: It's a good conversation to pair together.
JEANNETTE: Yeah.
KATY: And I'll just say that the article states fairly strongly that there is no cure or fix for a bunion beyond surgery. And they talk about - they're interviewing a podiatrist and the podiatrist is talking about, you know, "All of the things on the market that there are to fix bunions" and "they don't work." And I mean, one of them was apple cider vinegar.
JEANNETTE: Yeah, and Epsom salts, I think.
KATY: Yeah, right. And so I guess mechanically what I didn't see in this article was it talking about really the mechanics: the push and pull. And in a much bigger perspective, there's not a lot of talk on humans learning or correcting their push and pulls in general. Like we're not at that place, I think, with musculoskeletal situations
JEANNETTE: No. And it was interesting because he talks about splints.
KATY: Mm-hmm. Which is a push And pull.
JEANNETTE: Which is push and pull. And it's basically like, as soon as you take them off, you revert back, which I thought was interesting. Because maybe we don't think about the feet in the same way as they have muscles that can respond and change. So I thought it was interesting that he just dismissed. And I understand if it's just passive, there might be limited change you can make.
KATY: Yeah.
JEANNETTE: But there was no appreciation that you could change your pushes and pulls through corrective implements or corrective movements. It was straight, "That's useless," which I thought was interesting.
KATY: Well, and I think I run into this a lot. I do think it has a lot to do with training, we'll call it training volume of working on something. There are plenty of things on the market for foot issues that you wear at nighttime. And because our musculature is so habituated to our patterns, I think that a lot of the time just doing something like passive positioning in isolation - so splinting. I mean, it could even be something like, you know, I talk about wearing My Happy Feet socks at nighttime. That's passive too. To just do that in isolation and not do anything that affects the other pushes and pulls, I think you'd have a hard time "correcting a bunion". So I'm using air quotes for "correcting a bunion" because I think that you can make a lot of progress to mobilizing the area and improving your gait upon that foot. So it goes back to; What's the actual problem with the bunion? On one hand, it could be the actual pain or soreness of the area. But I think for many people, it has more to do with the way the toe, the great, the big toe, the hallux is moving and feeling when you're walking. And I think that there's a lot you can do to mobilize that area and strengthen that area and change the loads throughout your foot, so it poses less of a problem...
JEANNETTE: Right.
KATY: ...for you. And you're effectively not continuing to create it. Because I think with a bunion, you just keep making it. Once you're in that space, if you don't change your pushes and pulls the way you're walking is pushing and pulling that shape.
JEANNETTE: And it's kind of a positive feedback.
KATY: Absolutely.
JEANNETTE: Because of the shape is going in that direction, it makes it, multiply. So there's a few things. Can we address what to do with the toes and the alignment of the foot and how that could help people?
KATY: There was one section of this article that did talk about push and pull, whether it called it that or not. And that was talking about the people most prone to bunions. One, he said flat feet and I would say it's pronators. But I know that journalists will want to simplify it. Flat feet are not the same thing as pronation. So, people who have a lot of pronation in their feet and also people with joint laxity. So, we'll just say collagen disorder where many parts of their body aren't stable due to qualities in their connective tissue that are genetic. So, let's talk about pronation first. How do we clarify pronation for the people listening?
JEANNETTE: Could we describe pronation as the foot lowering and flattening to the floor and maybe rotating into that vulgar shape? Is that true?
KATY: Yes. Your foot is like a bag of bones. So when we think of anatomy, I do think we tend to think of parts staying in their general orientation and deviating, you know, getting longer or spreading. Those are two movements. The key thing that I think we're missing with bunions is that it's the rotation part. If you've read Whole Body Barefoot, what I'm trying to talk about is schmear, effectively. Pronation is just a description of motion. Schmear is the effect of that motion. So when your sole of your foot touches the ground and then your foot sort of spreads out and the bag of bones kind of rolls over onto itself a little bit, why this is important for bunions is you are pressing on the side of the bunion, which is a big part of why it can't resist that motion. It doesn't have the ligament orientation to resist pressure in this particular direction.
JEANNETTE: And is that why, sorry, a question, because often you see with a bunion, the toenail starts to look toward the midline. Like there's actually a twist.
KATY: Yes. The toe is rotated also. It is not just these two-dimensional deviations.
JEANNETTE: Right.
KATY: The bones themselves have rotated. You know, it's just like all the subtleties that I try to, teach with rotating your upper arm because it's not actually where you think it is and rotating your thigh because it's not actually where you think it is. The same with a bunion. It is not purely a lateral deviation. That's what you can see.
JEANNETTE: Mm-hmm.
KATY: It IS laterally deviated, but it's not only laterally deviated. And I think it's that rotation, this complex sort of arch structure that rocks over it. It's sort of, it's collapsing as it's spreading. And then every step that you're taking, even when your foot is seemingly flat, it's not flat. It's being pushed from the side and it buckles so easily in that particular orientation. And that's the push and pull.
JEANNETTE: Right.
KATY: But you've got multiple pushes and pulls there. It's just hard to see them all. Tri-planar movement is three pushes and pulls.
JEANNETTE: I think people use different terms, but I think they're slightly different. But like a medial heel whip, which I think might be when the foot is actually off the ground. But that kind of, what's the term I would use, an abductory twist ...
KATY: Uh-huh.
KATY: Well, and once that Hallux Valgus has started, you can't really extend your big toe in the way that we would say fits into a gait cycle. So you start abducting - you start turning out your feet even more so that you do not have to deal with the toe extension part of walking.
JEANNETTE: Right.
KATY: And that's when it really starts to reinforce itself because it's sore. You know, your joints bend in the directions that they bend. They're set up to articulate in certain ways. And the great toe is set up to really extend, you know, move straight up, curl down. It can also go side to side. It has that ability. But it's all about the volume of the ...
JEANNETTE: Right.
KATY: The muscular system is set up to resist and support, you know, mostly an extension - strength in extension. Really you're in that extended - and that's position as you pass over your foot when you're walking. And it does not have that same robust system to deal with the big toe being off to the side. So you turn your foot. So then you sort of roll on that foot even more. And then you're creating even more pressure which continues to push the bunion out to the side. So, what I like to help people do is, one, it's a lot of the same muscular things that we would want to do to come out of over-pronation.
JEANNETTE: Right.
KATY: And that's a lot of hip work. That's a lot of standing up straight-legged work. It's not only with the toes. I do think we tend to think, "I have this toe problem. I need just toe exercises." You do need toe exercises. You want to be in shoes that allow you to spread your toes widely, you know, as widely as you can.
JEANNETTE: And with a bunion, your feet can get even wider. Right? Because you have that extra mass. And that can be a challenge to find shoes.
KATY: Wide enough shoes. Right. Because you don't want to keep adding pressure. And that's another thing with kind of a callus that sits over that bunion because it's rubbing on things more often. And I know a lot of people with bunions will tend to go to sandals or things where they can get that pressure off of that area. So a wide enough shoe to accommodate or reduce the pressure from the shoe on the bunion. But also to give space so you can start to abduct. You can start to move those big toes in the opposite direction. And then trying to decrease that pronation. So, there's strength for that. Restoring some of the arch strength in your foot. Kind of unschmearing your foot and lifting it up and off of that area. And then gait then looking at how you're using your foot when you are walking. You're not going to be able to do that all the time because we're not able to be mindful with every step. But at least to start to become aware of options and set aside time to mobilize the foot and try to create a gait pattern that doesn't just blindly reinforce that issue.
JEANNETTE: Exactly. So possibly the best book is Whole Body Barefoot of yours. Or Move Your DNA. And you'd be looking for toe-spreading movements. You'd be looking for hip rotation. You'd be looking for standing leg strength. All of those pieces.
KATY: Mm-hmm. Backing your hips up.
JEANNETE: Yes. Getting the weight off the toes.
KATY: Getting the weight off the toes. We talk about pushes and pulls in the feet. Just having the hips sort of casually forward, which pushes a lot of weight on the toes. If you already have a bunion, that's another big push from the top that's pressing that shape into your body, not just into the ground, but into your body. So it really is a whole-body thing. But yeah, Whole Body Barefoot is where you're starting to develop this idea of, "Oh, I can actually use my hips and my legs to change the shape of my feet."
JEANNETTE: Right.
JEANNETTE: And actually that could be a movement break. Everyone could stand up and push their hips forward and see what happens to their feet. They'll probably get longer.
KATY: Watch what happens with your toes. Well, and also if you let your hips go way forward, really forward on your toes, you'll see the toes contract. They have to contract to keep you from pitching forward. So when you're dealing with anything in your toes: bunions, hammer toes Morton's neuroma, anything where the bone shape is creating pressure in other places. Note how your pelvic position absolutely creates a toe response.
JEANNETTE: Right.
KATY: And then you'll back your hips up and then you can look down and see, "Oh, I have more options with my toes when my hips are not directly over the toes." And that's why we don't wear heeled shoes.
JEANNETTE: Right.
KATY: That's why minimal shoes don't have healed shoes because there's this automatic relationship between what the toes absolutely have to do when your hips go forward.
JEANNETTE: Mm-Hmm.
KATY: If they don't do it, you would fall flat on your face. And so if you're trying to make any changes in there, back your hips up.
JEANNETTE: Free those toes.
JEANNETTE: Fantastic. So that's movement correctives. Which, in general, the article did not talk about. Do we want to contrast that with what they did talk about? Which was surgery.
KATY: Sure, yeah.
JEANNETTE: Just to talk to that part, which was really that "This is what you'll need to do."
KATY: Yeah. I mean, they're basically saying that surgery is the only way to get it into alignment.
JEANNETTE: Right. So there there's loads of different varieties in surgery. There are three groups. Right? There was one that just kind of took this shaving - the blown-off.
KATY: A shaving.
JEANNETTE: Which just takes the lump off and doesn't change the deviation of the...
KATY: Yeah. It doesn't adjust alignment.
JEANNETTE: ...just doesn't adjust the alignment. And then there was the Lapidus. Which is a fusion of the toes. So you essentially fuse the joint. You lose the mobility in that joint and it's realigned.
KATY: Realigned and fused.
JEANNETTE: Realigned and fused. And then there's also realignment without fusion. Which is you break the bones, put screws in, but don't actually fuse the joint.
KATY: Yeah.
JEANNETTE: And as far as I understand, the difference seems ... Some people, if you have arthritis, they recommend a Lapidus because the joint is not healthy enough to not be fused. Yeah, so those are the options. And you had found some work about the reoccurrence. Because it might be realigning, but it's not removing the pushes and pulls that you are repeatedly creating. Is that correct?
KATY: Yeah, reoccurrence is a big issue with the non-fusion options.
JEANNETTE: Right.
KATY: Because you haven't usually addressed the gait issue.
JEANNETTE: Mm-hmm.
KATY: And that is the biggest frustration I hear. Of course, the people that I hear from are the people seeking ...
JEANNETTE: Yes.
KATY: ... more help. You know, so if it worked for you and you went on your merry way, fantastic. But it often can regrow back or rechange because again, the problem is mechanical. It's in a web of forces that you're creating all the time that you can't see. But it's not like it just flopped out in that direction and that was what made the problem. The problem is like throwing a pot, a clay pot. You're throwing a bunion, you know, on the wheel. You're on the wheel and you're creating these forces here. And so if you cut off your clay and you get your clay all and you start again, but then you go back and you do the same spinning and you put your hands in the same place. It's the same set of pressure. You're going to create that same shape again.
JEANNETTE: Yeah. And I think the article really missed that. There was something I'm going to find the quote. Because I thought it was interesting if anyone has actually got it. It was, oh, here we go: "With increasing stress, the human big toe can override the muscles and ligaments that surround it drifting out of place." And toes don't just drift.
KATY: There's no drift about it, honey.
JEANNETTE: There's no drift. It has to be pushed or pulled there. And I think that's what this article did not do well.
KATY: But I was happy to see that the article at least mentioned footwear.
JEANNETTE: It definitely did. Yeah, it definitely did. Although it did mention ... that's a good point. Because it mentioned footwear particularly. It quoted the podiatrist again. And his comment about footwear was that it's unsupportive. The footwear we choose is unsupportive and the grounds that we walk on are very hard. And this is part of the problem. And it mentioned something about because we have unsupportive footwear, we're throwing our feet under the bus to kind of save our spines and our hips.
KATY: Where can you walk that's not hard? Where are we supposed to be walking?
JEANNETTE: So the podiatrist again was all for supportive, supported footwear.
KATY: Of course.
JEANNETTE: And I see that, especially, I think, from his perspective of the flat feet.
KATY: Mm-hmm. Right. If you have these pronation or hypermobility conditions, get shoes in there that really hold the bones in place so we don't have this drift.
JEANNETTE: Right. Mm-hmm.
KATY: Which was interesting. Because I would like to know, would we consider these medieval shoes supportive?
JEANNETTE: Not at all. They were kind of soft leather just with with points.
KATY: Like a ballet slipper with a needle on the front that you cram your toes into.
JEANNETTE: That's right. Yeah, they certainly wouldn't have had arch support. Yeah. So that's perhaps something to consider, isn't it? How if you've been told you need supportive footwear because you're an overpronator and your bunion is going to get worse? It might be a slower process. You've written about this. This transition to more minimal footwear, with the correctives, you know, rather than if you've been told you need this supportive footwear, how can you do the correctives you need and then get the foot movement you need?
JEANNETTE: Right.
KATY: Yeah. You know, the idea of minimal footwear ... I mean, the heel of a shoe would be something to get out of right away.
JEANNETTE: Yes.
KATY: You know, minimal footwear is a set of characteristics. It's not any particular shoe. Because getting out of the heel right away will allow you to get off of your toes right away. And then from there, I really think that the correctives are your main thread towards getting foot realignment, foot strength, and restoration coming out of hyper pronation. And then you could go to something with a flexible sole and wider. So that you're promoting more movement. And all of this depends on the person, the body. And you know, if you're younger and more malleable, then you can drop right into something. If you haven't been told that you need arch supports, you can move into this space more rapidly. If you have more years with particular habits with your feet and you're reluctant to get rid of your supportive shoes, just work on the correctives. Focus on the correctives. Definitely come down out of your heel too. And, you know, again, upper. I was talking about toes in your upper. The upper is the part of the shoe that connects your foot to the shoe. So, if you have a tennis shoe, the upper is the part with the laces. If you have a flip-flop, the upper is that teeny tiny strap. That's not a full attached upper. When you wear shoes that slide on they also slip off very easily. And so you have to push and you have to scrunch your toes to hold them on. Well, there is another push and pull that's in your foot all of the time. So you're trying to get rid of these pushes and pulls that are part of your clay pot-throwing set of forces that keep throwing the bunion shape. So you can get a fully attached shoe so you don't have to add toe-scrunching to hold your shoe on. You could back your hips up so you can allow toe relaxation. And then you can be working on these other things as well.
JEANNETTE: Yeah.
KATY: There's so much to do before you get rid of supportive shoes in the sense of an arch that you could just even set that aside for right now if you're feeling uncomfortable with the notion, and just do everything else.
JEANNETTE: Great.
KATY: And see how things go. You know, there are toe exercises to start getting out of that tension that's pulling you towards your pinky toe. Start stretching and strengthening in the other direction. The exercise that I gave at the beginning - the challenge in the introduction. Can you lift just your big toe and leave all your other toes down? If you have a bunion when you do that - and actually even if you don't have a bunion if you do that - you might see that your great toe, when you don't think about it, not only lifts. It lifts and goes towards the pinky toes. And so try to lift without also pulling. And you're going to get a different motion than if you lift alone. And you'll start getting cramps in the feet because you are using muscles that you don't usually use.
JEANNETTE: I love that one. It's interesting for me because my left is different from my right. So my right veers off a little bit more than my left. And my right foot is the foot that I'm more - it likes to turn out more.
KATY: The discrepancy between our right and left toes is very good evidence for the push and pull.
JEANNETTE: It is.
KATY: Because it's the same supportive shoes that you are or aren't wearing. It's the same genetics. You know, It's ...
JEANNETTE: It's the same foot pattern.
KATY: Exactly. You are your best sort of data point of comparing apples to apples. And when you see something create this particular shape, you want to be thinking, okay, pushes and pulls.
JEANNETTE: Hmm.
KATY: And pronation - We pronate to different degrees. We've got all of these things going on in the body that are happening without us really knowing how to see them. That's why in Move Your DNA weekends, we do knee pits.
JEANNETTE: Right.
KATY: Because knee pit is a big bunion thing.
JEANNETTE: Yes.
KATY: Knee pin alignment is a huge bunion contributor and ...
JEANNETTE: If people don't know what knee pits are, could we ...
KATY: We're not going to tell them.
JEANNETTE: We're not going to tell them.
KATY: It's a mystery.
JEANNETTE: Okay. Perhaps we could put a link in the show notes to knee pits.
KATY: So maybe we can make a video for listeners to ... We can put it in our stories or we can maybe embedded into the show notes.
JEANNETTE: Perfect. Yeah, we can do that.
KATY: We can use your knees? Can we use your knees?
JEANNETTE: I am a good knee pit model because I have very clear tendons on the back of my knees and I am more extremely internally rotated on my right. So it's quite easy to see the difference, which lines up with the fact that my right foot likes to turn out and my big toe likes to deviate off.
KATY: All Right. So we'll get them a video so, you get a sense of what these knee pits are. As far as the article goes, I think we've given it due diligence. My take on it was, I think the unfortunate part is it reinforces this idea that this thing going on in your body is kind of beyond your control. It has to do with your ape toes and your unsupportive shoes. And once you have it, there's nothing that can be done. And I don't think that's the case. I've seen enough people make a shift. Make a shift in actually the extent of their lateral deviation. The extent of their bunion shape. And then also just a reduction in the impact the shape has on their life. Two different things.
JEANNETTE: Right. That's the key. That's the key for people.
KATY: Exactly. Feeling empowered. So, thank you for coming on and talking to me about bunions. I mean, I think an hour about bunions is probably where we should stop.
JEANNETTE: Yeah. I think so.
KATY: And if you want to read more, Whole Body Barefoot, we can link to that in the show notes. You can buy it or get it from your library. Rethink Your Position.
JEANNETTE: Yeah. You have a lovely article in Rethink Your Position on bunions, which gives a nice summary.
KATY: Yeah, and it's really video-based. Come to a foot retreat so you can spend three days. And then of course, as always, you have to do the exercises. That is always the sticking point: knowing about how a bunion is made is not enough to undo it. All right, well, thanks for coming.
(Theme music)
JEANNETTE: Oh, thanks for having me.
KATY: Yep.
JEANNETTE: Bye.
Hi, my name is Jennifer Derryberry Mann from Nurture Nashville Yoga. This has been Move Your DNA with Katy Bowman, a podcast about movement. We hope you find the general information in this podcast informative and helpful, but it is not intended to replace medical advice and should not be used as such.
Our theme music was performed by Dan MacCormack. This podcast is produced by Brock Armstrong and is transcribed by Annette Yen. Make sure to subscribe to this podcast wherever you listen to audio and find out more about Katy, her books, and her movement programs at NutritiousMovement.com.
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