How do shoes cause bunions , corns, hammer toes, ingrown toenails ?
It is a well observed and well documented fact that poorly fitting footwear can cause foot problems to arise in people who previously had no foot troubles. Whilst fact remains, people often still persist with shoes that are either too narrow or too small for their feet and often present to podiatry clinics with a number of different problems. Some of the most common problems I have seen in patients who have presented to the clinic are listed below and have often had footwear choice as major contributing factor to the development of problems.
Corns
Corns are simply concentrated areas of callous (hard skin) that develop as a response of the body to areas of pressure. Common sites for corns includes inbetween the toes, on the sides of the pinky toes and potentially on the tips of the toes. Treatment usually involves removal of the corn and reduction of the area of pressure.
Bunions
Bunions are commonly enlargements of the area around the bone of the big toe joint. The initial swelling and fluid will harden to form a solid and restrictive deformity which can become painful and make it hard to fit shoes properly. Whilst genetics has been shown to play a role in development of bunions, the use of tight or narrow shoes gradually forces the large toe out of position which exposes the joint to further pressures. This malalignment over time becomes a permanent deformity which may in turn force the other toes out of alignment and affect foot function overall.
Ingrown toenails
A very common complaint that a lot of the time is linked to wearing shoes that are either too tight or too small. Nail matter is generally quite susceptible to pressure and as such, shoes that are considered too tight or too small may force the nails to twist inwards and become lodged in the flesh of the big toe. With time, the constant pressure of the nail on the skin leads to inflammation and potentially infection which can be quite painful to touch and treat.
Hammer toes and overriding and underriding toes
Whilst both of these types of deformities can stem from genetics or other pre-existing problems like bunions, footwear can be a large causative factor. Hammertoes appear as a retraction of the digit with the middle of the toe in an elevated position resulting in curling over the neighbouring toe. Underriding and overriding toes often occurs between the second and third toes although it can occur on any toe. Constant pressure from tight or small footwear can cause toes to become compressed and one can often be forced underneath or over the other. Over time and with constant pressure, this deformity can become permanent and impact on the function of the foot.
The best treatment for these sorts of problems, is prevention. When purchasing shoes the following should always be considered:
* The toes should not feel pinched or cramped when trying shoes. Leather shoe will stretch a little bit, however never enough to make an uncomfortable shoe, comfortable.
* Shoes with adequate space and width in the toe box is ideal. A thumbs width length of space at the front of the shoe (from the longest toe) is usually the appropriate amount of forefoot space.
* Shoes should be built relatively sturdily. Avoid shoes that can twist through the midsole easily or crumple on compression of the material around the heel.
* Avoid, where possible, heels or dress shoes with pointy-toed designs as they compress the toes in a small environment and may predispose a person to injury.
Dr Anel Kapur (Podiatrist)
