Bunion night splints

About the heriditability aspect...
I'm not a podiatrician, but I know that recent research seems to suggest that at heriditary aspects may contribute at least to bunions (hallux valgus) in people under 60.
A collegue of mine (an orthopedic surgeon) told me hallux valgus in children definitely runs in SOME families en is than heridited through the mother with an uneven penetration of about 70 %.

But like also in my domain of medicine... I'm sure that both genetics and environmental factors come into play here...
What is inherited is probably a weaker/predisposing bone structure , that through the use of high heels and/or shoes with a narrow toe-case leads to the deformation. (predisposing bone structure: bigger angle between first and second metatarsal, sometimes accompanied by an additional articulation between the bases of the two metatarsals, as my collegue explaned me.)
 
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Like I said, I get it it just sucks for us poor folks.

Nick, you need to find a doc that participates in your plan. But remember, it sounds like you are looking for PF relief not involving orthotics, shoes, or surgery.
The information you need is available from sources other than a doctor's consultation, for example right here in the BRS.
 
About the heriditability aspect...
I'm not a podiatrician, but I know that recent research seems to suggest that at heriditary aspects may contribute at least to bunions (hallux valgus) in people under 60.
A collegue of mine (an orthopedic surgeon) told me hallux valgus in children definitely runs in SOME families en is than heridited through the mother with an uneven penetration of about 70 %.

But like also in my domain of medicine... I'm sure that both genetics and environmental factors come into play here...
What is inherited is probably a weaker/predisposing bone structure , that through the use of high heels and/or shoes with a narrow toe-case leads to the deformation. (predisposing bone structure: bigger angle between first and second metatarsal, sometimes accompanied by an additional articulation between the bases of the two metatarsals, as my collegue explaned me.)

Thank you for the well thought out and written overview of the bunion etiology. Instead of editing down the quote I left the whole thing because it bears repeating. Too often forums like this one include speculation as if it's fact, confusing readers who have not done their own research.
As you know there is a very well established genetic link, as well as an environmental cause.
Some 60 year old women have worn pointy heels for life and aside from a shortened achilles tendon show no other pathology, while some teenage girls who wore "sensible" shoes require surgery at a very young age.
 
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Nick, you need to find a doc that participates in your plan. But remember, it sounds like you are looking for PF relief not involving orthotics, shoes, or surgery.
The information you need is available from sources other than a doctor's consultation, for example right here in the BRS.
LB, I just haven't found a bf friendly pod around here other than Dr Ray, and unfortunately Dr Ray doesn't ACCEPT insurance. He gives you forms so you can be reimbursed, but you still have to pay out of pocket in the first place... I have followed sock docs advice for pf, I've followed my old pod's advice, I've followed many different advices on pf and so far nothing is really working all that well. I spend a good half hour a day or more doing the exercises, rolling, mashing a couple of the trigger points that I know are actually trigger points, and stretches in addition to now wearing shoes to try to combat this pf. In any case, that's neither here nor there, I just wish our system wasn't flawed so that drs wouldn't feel the need to not accept insurance. I would prefer to be able to have a choice in being able to go to Dr Ray. Unfortunately that's not the way it is.
 
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This makes me think of the research done by Weston Price and his studies on Aborigine tribes in the 1930s. Basically they were cavity free and had healthy, wide jaws with no dental problems (Price was a dentist) until the Western diet (refined foods) was brought in. Then significant structural changes were seen in future generations even before those affected were consuming the unhealthy foods. So these changes too could be considered "genetic" but really what happened was the population was altering their genetic expression because of the dietary/environmental changes. Is there a similar correlation to hallux valgus and bunions? I don't know but I think you can make a strong case for it, unless non-shoe wearing natives are truly eating a wholesome, unaltered diet - pretty hard to find today as most of those tribes have become wiped out. It's so hard to study "healthy" humans since in most studies healthy simply means cancer and disease free.
 
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Hallux Valgus Inheritance: Pedigree Research in 350 Patients With Bunion Deformity
"Our objective was to construct 3-generation pedigree charts"
So were those 3 generations of shoe-wearing family members? Would they have had bunions, had they worn shoes with nice wide toe-boxes (if available back then)?
The aetiology of hallux valgus: a critical review of the literature
"While the condition is more common in shoewearing populations, shoes have not been shown to cause the problem."
I didn't pay the $31.50 for the article, so I can't say judge what evidence this statement is based on.
"Metatarsus primus varus is a significant and possibly the primary component of hallux valgus"
So without shoes, would metatarsus primus varus cause hallux valgus, or would most people's feet end up like this native?
Normal-foot.jpg


"Pronation of the foot has been associated with hallux valgus"
Then, what is the incidence of pronation with and without shoes?

Thought question: What is the incidence of hallux valgus in the fossil records/remains of predominantly barefoot cultures?
 
That is the question Sid. I like the thought question. It's a good discussion. BTW - pronation is normal. Shoes often limit normal pronation (and sometimes even normal supination).
 
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but really what happened was the population was altering their genetic expression because of the dietary/environmental changes

Definitely. Environment has changed a lot, and thus, so has phenotypic expression.
Merriam-Webster: Definition of PHENOTYPE
the observable properties of an organism that are produced by the interaction of the genotype and the environment
 
Price's photographs of Aborigines on their native diets illustrate dental structures so perfect as to make the reader wonder whether these natives were wearing false teeth. But like all the other primitive groups Price studied, the Aborigines soon succumbed to rampant tooth decay and disease of every type when they adopted the "displacing foods of modern commerce" - white flour and sugar, jams, canned foods and tea. Children born to the next generation developed irregularities of the dental arches with conspicuous facial deformities - patterns that mimicked those seen in white civilizations.

This is the only reference I could find, and it isn't really clear whether or not the children of the next generation were exposed to the refined sugars during their primary dentition years or not. I would assume that they were, why would'nt they be?
Does anyone have a link to a reference describing what was being implied by Dr. Gangemi?
 
There's a reason Dr. Ray (and others such as myself) don't take insurance - we don't want to work by their rules and it weeds out patients who are typically less compliant.

Though I am fortunate enough to have insurance, sometimes I find it simpler to just pay the provider. That way, it's just between me and them, and no intermediary to skim profits or limit my care. The provider and I can negotiate a fair price, rather than one that is set by the insurance company. No deductibles to mess around with, either.

I'm resigned to the fact that I'm pretty healthy and that my premiums go to pay for the care of others who may be less fortunate or less apt to take care of themselves. I also have it for family members.

But yeah, if I need something big and expensive done, then hey, my insurance number is on my RoadID!
 
A question for SockDoc:
Regarding the picture that I posted above with the native. Would that be within accepted normal variation of the foot, or would it be expected to cause problems at some point due to being flatfooted or otherwise?

I watch a decent amount of documentaries, and I've seen fairly wide feet in barefoot populations, but not to that extent.
 
A question for SockDoc:
Regarding the picture that I posted above with the native. Would that be within accepted normal variation of the foot, or would it be expected to cause problems at some point due to being flatfooted or otherwise?

I watch a decent amount of documentaries, and I've seen fairly wide feet in barefoot populations, but not to that extent.

I'm not sure Sid. I'd say yes it's normal because the toes are lined up nicely and the foot is naturally wide. I'm sure many have noticed that going barefoot for some time naturally widens your foot; I have.

There is no problem with being flat footed - the arch of the foot has little if any relationship to function. More on that here (and research too in this post I wrote for those who need research to see validity in anything).
http://www.drgangemi.com/2012/03/flat-feet/
 
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I'm not sure Sid.
I respect and admire your frankness.
I'd say yes it's normal because the toes are lined up nicely and the foot is naturally wide. I'm sure many have noticed that going barefoot for some time naturally widens your foot; I have.
As well as your expertise and opinion.
There is no problem with being flat footed - the arch of the foot has little if any relationship to function.
Thanks for the informative link and all of the great information!
 
Price's photographs of Aborigines on their native diets illustrate dental structures so perfect as to make the reader wonder whether these natives were wearing false teeth. But like all the other primitive groups Price studied, the Aborigines soon succumbed to rampant tooth decay and disease of every type when they adopted the "displacing foods of modern commerce" - white flour and sugar, jams, canned foods and tea. Children born to the next generation developed irregularities of the dental arches with conspicuous facial deformities - patterns that mimicked those seen in white civilizations.

This is the only reference I could find, and it isn't really clear whether or not the children of the next generation were exposed to the refined sugars during their primary dentition years or not. I would assume that they were, why would'nt they be?
Does anyone have a link to a reference describing what was being implied by Dr. Gangemi?


Longboard - have you seen this?

http://www.sciencemag.org/content/336/6084/973.full

I listened to the podcast.
 

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