Behind the design: Our unique features for Bunion sufferers

26 Feb 2021

What's a bunion?

A bunion is an enlargement of the big toe joint. Technically called, hallux valgus deformity. It occurs as a result of the misalignment of the bones on that side of the foot, leading to stretching of the ligaments and tendons around the big toe joint. There may also be additional bone formation - growth of a bony lump on the side of the big toe joint (called an exostosis). Bunions often cause pain and symptoms on the inside edge of the foot, the sole of the foot, and even the small toes and are progressive, meaning they can worsen over time. They are a very common foot deformity, affecting 23% of 18 to 65 year old’s and being more common with older age(1). Women are more often affected than men, and a family history of bunions is common(2). Bunions have also been linked to poor footwear choices in earlier life(3-5).

1. Giving your bunion space

Ill-fitting shoes have been seen to be associated with bunion formation and symptoms(4-6). That’s why our half-length Sole Hero® footbeds are a core feature to bunion relief.

It is offered in styles which contain our Sole Saver Pack®. These footbeds provide the same level of arch support as our full length footbeds. Being a half-length support footbed means they provide the maximum amount of volume in the toe area by not taking up space in the toe box. This enables us to create fashionable looking shoes that have a profile that still looks slimline.

Bunion only on one side? Wear the half length footbed on your affected side, and the full length footbed on your unaffected side. TheSole Saver Pack® is perfect for women who have tricky to fit feet because of bunions.

2. Supporting your bunion

Our footwear, whether worn with the full length or half-length support footbeds, have been purposely designed to support the medial arch. Our footbeds are made of two materials to enhance wearer comfort with the arch support.

3. Cushioning your bunion

Cushioning may be important for bunion relief(8)- our cushioning is strategically placed where it is needed to help provide symptomatic relief for bunion pain. Our soles and footbeds work together to create our Support & Cushion Layer System, giving a unique combination of both stability and cushioning.

If you choose to wear the half-length footbed, you will still have ample softness under your forefoot due to the hidden cushioning layer on top of our soles. More space for your bunion without having to compromise on cushioning - clever!

4. Reducing the rub on your bunion

Most of our enclosed styles have a hidden soft foam lining in the forefoot area to minimise friction, pressure (and shear stress) over the skin around the forefoot. This is ideal for women with bunions as the joint often protrudes creating higher pressure of the joint on the upper(9).

Caroline McCulloch, Founder

B. Podiatry, B. Physiotherapy

Alan McCulloch, Founder

B. Podiatry, B. Physiotherapy

Sara Taylor, Podiatrist

B. Podiatry (Hons)e

Dr Sheree Hurn, PhD | Podiatrist and Clinical Researcher

“My research has shown that footwear advice is the most common treatment recommendation from podiatrists for bunions. I have also found that those with bunions have difficulty finding footwear that both fits well and looks fashionable.

I often recommend FRANKIE4 sneakers to my patients, and with the Sole Saver Pack® and trained footwear fitting staff, I’ve had great feedback about these styles. Keep up the great work FRANKIE4!”

More Information On Bunions (Hallux Valgus)

Diagnosis & Classification

Diagnosis of hallux valgus can usually be made with the patient standing barefoot by assessing the joint angle visually, and can be measured with a goniometer. More accurately though, the joint deformity can be measured by weight bearing x-ray views (10).

If the angle between the first toe and the first metatarsal exceeds 15 degrees, the angle of the joint is out of normal range. The metatarsals often look splayed and the first toe becomes rotated. Though not required for diagnosis, clinicians should also assess the mobility of the deformity and the position of the hindfoot to see if these are contributing factors (10).

Without x-ray or imaging, previous techniques for categorizing and monitoring hallux valgus development have included tracing around the foot, measuring the joint angle, measuring the girth of the foot, or taking photographs(11). The Manchester scale was developed by Garrow et.al.(12) for a more uniform grading system. The Manchester Scale classifies hallux valgus using four clinical photographs:

No deformity: Grade 1
Mild deformity: Grade 2
Moderate deformity: Grade 3
Severe deformity: Grade 4

Click this link to view Manchester Scale images(13).

In clinical practice Dr Sheree Hurn recommends describing hallux valgus as ‘mild, moderate, or severe’, using the Manchester Scale images as a reference, to enable clear communication between practitioners. She also recommends taking measurements from clinical photography if possible to track progression of hallux valgus (11).

Extrinsic Factors

Footwear

Some studies have linked poor footwear to the formation of hallux valgus (3-5), and experts have reported that poor footwear exacerbates symptoms and contributes to the acceleration of the disease (6, 14).

The higher prevalence of hallux valgus among women may be due to the use of footwear that is either poorly fitting or less forgiving. Frey at al. in a survey of 356 women found that 88% of women were wearing shoes that were too small (15). Menz et al. reported that hallux valgus was more likely in women who had worn shoes with a narrow toe box between the ages of 20 – 29 (4).

Excessively high (over 2 inches), unstable heels have been associated with hallux valgus development. Women between the ages of 20 – 64 who wore high heels as their daily shoes had a higher incidence of hallux valgus than those who did not. This is probably due to increased forefoot pressure over a long period of time (5).

To summarise, a number of studies have found various links between hallux valgus and footwear. Both footwear that is too narrow, and heels that are too high have been identified as problematic, however no solid conclusions can be drawn as to what footwear features are the exact cause.

The role of footwear is very hard to measure as most people wear many different types of shoes along with spending time barefoot. However, if we think about it logically and apply what we as health practitioners know, hallux valgus is degenerative, progressive and painful. Our footwear prescription can be used like any other intervention to provide “relative rest” to the affected joint, cushioning for immediate relief and to also help facilitate a better rest position and movement. In fact, footwear advice and/or modification are the most common treatments recommended by podiatrists for hallux valgus, along with foot orthoses (16).

Occupation/Lifestyle

The slow progressive development of hallux valgus suggests repetitive excessive loading of the joint may be a contributing factor. However, despite this there is not yet any proven link between occupation and the development of hallux valgus. There has been a weak link found only in ballet dancers (14).

Intrinsic Factors

Genetics

Genetic inheritance has long been suspected. One study showed that 90% of 350 presenting cases had at least one relative also affected by hallux valgus (17), and another reported 68% of presenting cases showed a familial tendency (18). Hannan et al. confirmed the high heritability of hallux valgus in a large sample of 2,446 adults (2). One thing is for sure, it is in the genes!

Sex

The true sex ratio is unknown as it varies across population groups. The male to female ratio is 1:15 among those who have corrective surgery - however this may say more about who presents for surgery than actual occurrence (19). A systematic review found that the prevalence of hallux valgus was 2.3 times higher in women than men (1). Studies agree that women are suffering from hallux valgus at a higher rate than men!

Ligamentous Laxity

Ligamentous laxity is an inherited collagen imbalance of the connective tissue. Hallux valgus occurs more commonly in people with ligamentous laxity. In saying this, conditions associated with ligamentous laxity – such as rheumatoid arthritis are often associated with increased incidence of hallux valgus (14).

Age

The peak onset of hallux valgus is seen between 30 and 60 years of age. However, this does not mean it is something to be ignored before then! Initial joint changes usually occur in adolescence (14).

Foot Type

Many anatomical features of the foot have been studied to investigate their association with hallux valgus. Some require x-rays and invasive tests while others are more visible clinically. Three easy things to look for that have been associated with hallux valgus include:

Lowered medial longitudinal arch height – studies show those presenting with hallux valgus typically have a lowering of the first metatarsocuneiform joint visible on x-ray (20, 21). Clinically it is easy to view the arch height and make judgement as to whether it is low, normal or high.
Hypermobile first ray – there is a highly significant relationship between hypermobile first ray and hallux valgus at presentation (21).
Long first ray - 80% of those studied had a first ray equal to or longer than second (14).

Muscle Strength

Research has shown that the intrinsic muscles of the foot are weakened in those with hallux valgus (22). These stabilising muscles are important for balance and effective toe-off during walking. Due to insufficient research in this area, it is unclear whether muscle weakness is a cause of hallux valgus, or whether the weakness develops secondary to the poor alignment of the big toe.

Development

According to Perera et al. (14), hallux valgus usually develops slowly over time and he lists the deformity development usually occuring in the following order:

Failure of medial sesamoid and medial collateral ligaments of the first metatarsophalangeal joint.
Medial displacement of the first metatarsal.
Valgus rotation of the proximal phalanx.
Cartilage damage due to new position of medial sesamoid and lateral sesamoid appears to sit in intermetatarsal space.
Thickening of the bursa over the medial aspect of the joint – true ‘bunion’ appearance begins.
The extensor hallucis longus and flexor hallucis longus tendons appear to bowstring laterally, increasing the valgus displacement.
Metatarsal head drops off the sesamoids and pronates.
Abductor hallucis muscle becomes dysfunctional.
Dorsal joint capsule, no longer reinforced by tendons, is unstable.
Pressure can be transferred laterally due to first metatarsal displacement.

For copy and image reference in this section (Parera et. al. 2011)

Relevance & Reflection

FRANKIE4 footwear designs have two goals when it comes to providing relief for women who suffer from hallux valgus;

Accommodation of the existing deformity
Help with redistribution of pressure under the foot

Accommodation of the existing deformity

Changing shoe brands or styles can often resolve symptoms associated with hallux valgus. Recommended shoe features are a wide toe box and a shoe upper that is made of pliable material such as soft leather (9).

Not all women want to wear shoes with a ‘wide toe box’ because they can look unfashionable, or ‘orthopedic’ in nature. To maintain a slimmer toe box profile, the use of our ‘half length footbeds’ enables the toe area of the shoe to have more volume without ‘looking chunky’ and compromising on style. This is simply because our half length footbeds do not take up any space in the toe box area.

Further on our half length footbeds. Our Sole HeroTM half-length footbeds are podiatrist designed. Whilst they are not a custom orthotic, they are a foot support device designed with the aim to alleviate and prevent common foot symptoms offering comfortable contoured support and cushioning.

A study carried out by Doty et al. (23) recommended the use of ¾ length orthoses for treatment of hallux valgus. Whilst different terminology, ‘¾ length’ is the same length as our ‘half length’ support footbeds. Their recommendation that if a clinician uses orthoses as a treatment option for hallux valgus, a ¾ length orthosis might be a better choice than a sulcus-or full length orthosis. Based on their findings, full length orthoses actually increased dorsal/medial in-shoe pressures in HV.

Now focusing on the upper to accommodate the hallux valgus. Our footwear styles that are suitable for hallux valgus sufferers have soft leather uppers and also feature a soft foam lining in the toe box area to help decrease pressure (and friction) on their bunion (and surrounding skin).

Our aim of assisting with distribution of pressure under the foot

Studies have shown that high pressures under the medial forefoot are associated with hallux valgus (8), and a clinical trial by Torkki et al. (24) found significant pain relief with the use of foot orthoses in adults with hallux valgus. Experts recommend that supporting the medial longitudinal arch may improve symptoms, as well as preventing pronation of the forefoot, which accentuates valgus forces on the hallux (9).

Our Podiatrist designed FRANKIE4 Sole HeroTM support footbeds, whether full length or half length, aim to support the wearers medial longitudinal arch with the heel cradle and arch support contours.

Another arch we consider is the transverse arch, with the aim to help distribute pressure under the forefoot - our philosophy - soft smooth support to increase customer comfort.

At FRANKIE4 we’ve designed our transverse arch support in our footbeds to provide a smooth gentle forefoot support. We choose to have our footbeds to be dual (or more) density to help bias cushioning for comfort. The contour varies from our flat shoes to our high heels for comfort reasons, and the fact the foot biomechanics and needs are different depending on how high the wearers heel is compared to the forefoot. But as a whole our forefoot support is designed to have contours that cover a larger surface area under the foot rather a fixed metatarsal dome.

Research has shown that both plantar forefoot cushioning and metatarsal domes alleviate forefoot pain. However, the dome padding was seen to be significantly more sensitive to placement than the forefoot cushion (25). For this reason we avoid metatarsal domes with a ‘fixed built-in’ height, shape and location on our footbeds. Instead we opt for the use of a gentle plantar forefoot cushioning curve to support the transverse arch. What this means is that, if needed, a metatarsal dome, or metatarsal bar, or any other insole addition, that is the most ideal shape and size can be added onto our footbeds in the correct location for that particular wearers foot. This can easily be done with our footbeds if needed by a Podiatrist, or Physiotherapist, or other person educated on placement and understanding of wearer comfort and pain relief.

To help demonstrate the FRANKIE4 transverse arch support - refer to the footage in the middle on the bottom that shows the insides of our footbeds. We’ve strategically designed our footbeds to provide a soft, gentle transverse arch support; our goal is to reduce wearer symptoms, so comfort is critical. It is common for health professionals to prescribe a metatarsal dome when treating various forefoot conditions such as hallux valgus (9, 10). We agree that this is a great treatment option when the metatarsal dome has been placed on the footbed in a position tailored to the individual foot.

DISCOVER BUNION RELIEF

References

Disclaimer: The contributors to this article make every effort to make sure the information provided is accurate. All content is created for informational purposes only. The information regarding our products is not intended to replace professional or medical advice relevant to your circumstances. Discontinue use if you experience discomfort and seek advice from your health care professional.

This article contains copyrighted material. Reproduction and distribution of this article without written permission from FRANKIE4 footwear is prohibited. ©2021 FRANKIE4 footwear. All rights reserved.

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