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Family History Plays Large Role in Developing Bunions

Hallux valgus, or bunions, is a chronic condition caused by the deformation of the joint just below the big toe, the metatarsophalangeal joint. It can be identified by the big toe moving towards the other toes, with a large bump forming to the side of the foot.

Although there aren't any firm statistics, reports of adults with bunions are estimated anywhere from 28.4 percent to 64.7 percent. Researchers Coughlin and Jones studied data of patients with bunions and they found that 83 percent of patients had a family history of bunions, and wearing constricting shoes and the type of occupation only made up 34 percent of causes. Another study reported that the body mass index and wearing high heels contributes to bunion formation in women between 20 years and 64 years. It was thought that dancers, who put a lot of stress on the toe joint, would have a higher rate of bunions, but this didn't show in the research data.

The authors of this article undertook a study to determine the prevalence of bunions in relation to wearing high heels among Chinese women. Researchers distributed questionnaires to women in Hong Kong between the ages of 18 and 65 years. A total of 1,080 women responded and 98 percent of the responses (1,056) were usable. They were asked to rate their feet according to photographs included in the questionnaire that demonstrated how a foot looks according to degree of bunion. The women were also asked questions about family history, if they had foot problems, how often they wear high heels, pain and symptoms and if they have any effect on their daily life, as well as any diagnosis and treatment they may have received.

The women were from different socioeconomic backgrounds:

- 29.7 percent, clerical workers
- 4.4 percent, salespersons
- 6.2 percent, flight attendants
- 4.5 percent, service workers
- 12 percent, teachers
- 6.8 percent, discipline force
- 6.4 percent, health care
- 30.1 percent, housewives

In all, 36.5 percent reported having some sort of bunions: 29.5 percent (312) said they were mild, 4.8 percent moderate (50), and 2.2 percent (24) severe. When breaking this down by age, the older women had a higher incidence of bunions:

- 18 years to 40 years: 65.8 percent normal feet, 29.5 percent mild bunions, 3.7 percent moderate, 1.1 percent severe
- 41 years to 65 years: 58.6 percent normal feet, 29.4 percent mild bunions, 7.4 percent moderate, 4.6 percent severe

Two hundred twenty six women said they always wore high heels, while 453 reported wearing them sometimes, with the average length of time for wearing the heels being 9.4 years. Of just the women who had bunions, the average length was 10 years.

Family history was noticeable. Of those who had bunions, 88 percent said they had family members who also had them. Interestingly, 73.2 percent of this group did not wear high heels regularly. Of women who did not have a family history of bunions and wore heels often, only 2.8 percent had bunions.

Complaints that the women with bunions had included feeling that their legs felt tired, pain in the bunion area, changes in daily walking, balance issues, and effects on their daily work. However, only 93 percent of women with bunions contacted a doctor, as did 93 percent consult a physiotherapist. Eighty three percent used an orthotic device (insert for a shoe), 61 percent added a foot pad, and 43 percent bought wider boxed shoes.

The authors found that their study's prevalence was 36.5 percent for bunions, closer to the 33 percent in other studies. Although many say it is the wearing of high heels and constricting shoes that cause bunions, research isn't backing this up. High heels aren't harmless though. Steady use can put too much force on the feet, ankles, knees, and lower back, which are not meant to have that much force. As well, the position of the feet in the high heels puts tremendous pressure on the plantar (bottom) of the forefoot. The authors concluded that heels were not the main issue, but "a family history appeared to be a major concern for developing hallux valgus in Chinese females."


Daniel Wu, MD, and Lobo Louie, DPE. Does Wearing High-heeled Shoe Cause Hallux Valgus? In The Foot and Ankle Online Journal. May 2010.

06/17/2010

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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