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“Bunions”: Making the foot fit the shoe

There are about one million six hundred thousand references to “bunions” on the internet. By extrapolation from some hundreds of papers, my estimate is that one million four hundred and fifty thousand papers give the cause as “wrong/tight shoes”. And yet there is not one shred of evidence that this is the case.
Humans are good at mass misinterpretation, and I can only suppose that this delusion derived from the following observations quasi-logical assumptions and disinformation:

 

 

  • The Chinese were able to distort children’s’ feet by binding.
  • Women wear fashion shoes therefore women have deformed feet
  • It is an old trick of the medical profession, when they do not know a cure, to put the blame on the patient’s past behaviour, in an interesting twist of rationale which usually works.
  • Or is this a varient of “hear one, say one, believe one”?

 

Before addressing the prompts above let us look at the only serious attempt that I know to give a scientific basis to this conclusion.

It was claimed that women on Hong Kong Island had a higher frequency of deformed feet. It was known that woman on the island earned more than those in Kowloon, and it was said that this allowed them to buy, and wear, fashion shoes more often.

It was also claimed that women in Kowloon did not wear fashion shoes often, and did not often have deformed feet.

 

So the syllogism went like this:

Women wearing funny shoes have funny feet:

Women who do not wear funny shoes do not have funny feet:

Therefore funny shoes cause funny feet.

 

In fact this is a logical fallacy (technically affirming the antecedent), just as:

Rain makes the streets wet

The streets are wet

Therefore it rained – again a fallacy.

 

Returning to the other suppositions,

Chinese children were bound from an early age when cartilage precursors were distortable. Funny shoes are used far later in development. We all know that even incrementally tight shoes are uncomfortable, so it is unlikely that any adult or child would tolerate tight shoes, certainly not long enough to deform the anatomy.

If fashion shoes are worn they are seldom worn for more than one third of the day.

I have heard often “I was naughty when I was a girl, and wore the wrong shoes, now look at my feet!” It is ludicrous to suppose that some mechanical factor sixty years before could produce abnormalities in an octogenarian.

 

What do we know?

  • Men get bunions, although less frequently. Even if some men wear women’s fashion shoes it is unlikely that this would be for more that a short time and infrequently.
  • We know that there is a strong genetic transmission {I have been able to identify various types of transmission, including father to daughter, although mother to daughter is common).
  • There is a strong gender bias in the heredity.
  • I have treated people with bunions who have never worn shoes.
  • The incidence of bunions is higher in diseases such as diabetes, peripheral vascular disease, rheumatoid arthritis and polio.

 

I would be delighted if even one of the one million four hundred and fifty thousand authors who claim that shoes cause bunions would offer me proof.

 

 

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3 Responses

  1. HI, i am unlucky enough to have a large bunion on my right foot, much less on my right (male, late 20s).
    I also have severely flat feet (!) which I beleive has led to the bunions forming in combination with how my feet sit uncomfortable in many styles of shoes , with the flat arch resting over the insep, heel sliding out, and consequently puttingpressure on my big toe.
    Also feel my right foot is flatter adn causes me more discomfort in the “arch” than my left.
    Intersted in your theories though …

  2. do you know of the more modern and less invasive techniques for bunion surgery being succesful in a child? My daughter, age 12, also diabetic and hypothyroid has bad bunions and her consultant is recommending the conventiional method of which I am afraid of the long recovery periods and the impact this will have on my daughter’s blood sugars. He is close to 70 so am wondering if he just has no experience in the newer methods

    • In broad terms I believe that division of the metatarsal bones (which is what I believe you mean) is contraindicated in your daughter. I have written to you directly, with a request for more, specific, information.

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