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- Welcome my friends to the Bob and Brad podcast.
My name is Mike Kenitz,
and today I'm interviewing Dr. Ray McClanahan,
who is a podiatrist
and works at the Northwest Foot and Ankle Center,
located in Portland, Oregon.
He is also the creator of the Correct Toes toe spacers
which we will talk about later on in the podcast.
Today we're talking about foot health,
how to fix bunions without surgery, heel pain,
hammer toes, shin splints, and plantar fasciitis,
or plantar facetious,
depending upon what you want to call it.
If you are watching this on our main YouTube channel
and would like to hear the whole episode, you could find it
on the Bob and Brad Podcast's YouTube channel
or anywhere else podcasts are streamed.
So without further ado, here is Dr. Ray McClanahan.
So can someone fix a bunion without having surgery?
- It depends.
Most people can, but there's a subset of people
that allow their big toe to go away
from where it's supposed to be.
So let's see away from where it's supposed to be
like this towards the second toe.
And if the big toe pushes the metatarsal, let's see it.
I'm doing it backwards, so I think I'll just discuss it,
instead of trying to do a graphic.
If the big toe pushes against the inside part
of the metatarsal bone for too long,
it will literally create a space
between the first metatarsal bone
and the second metatarsal bone
which generally does not reduce itself.
We can get those people's big toe straighter
and if we improve the footwear
we can probably get them out of pain.
But there are a small portion of folks
that this is not gonna reduce the bump completely.
Now these folks are typically sixth, seventh decade.
They're typically females who most of their life
they were in that tapered toe box position.
And for the ladies, you don't even have to
wear a stiletto high heel shoe to get a bunion.
All you need to do is wear the shoes that are sold
to you based on the metal measuring device,
The Brannock Device and you'll still get a bunion.
So the answer to your question Mike,
really depends upon is there flexibility in the bunion?
In other words, can the client take their big toe
and pull it away from their second toe and make it straight?
If they can do that, they'll have success with this.
In other words, if they have the mobility,
can wear some kind of a toe spacer
and are willing to wear the shoes like you and I wear
then they will slowly see their bunion reducing.
And for anybody in the audience that may consider doing this
I encourage you to take a picture of your feet
from top to bottom before you start this
because it's slow and sometimes it's ungratifying slow
but most of the people we work with, it does work.
For instance, for me, it took me three and a half years,
but I would consider myself to have been a severe case.
For young people, we'll see, we've got testimonials
on our website, people reversing them in nine months
and these are pictures and they're not photoshopped.
We're not trying to sell product.
We're really trying to provide optimism
and hope that this can happen
because most people that I talk to day to day,
including yesterday,
are told that this can't be non-surgically corrected.
And that's not true.
So for the audience, anybody that's got a bunion,
got a family member with a bunion
dive into this information
give it a try because it will work for you.
But more importantly, Mike, even if somebody
in the audience has a bunionectomy
these principles are still applicable.
When I have somebody with a bunion, I tell them
we're gonna go this natural path,
but even if you need an operation,
we're not wasting our time
because if you need the operation,
you'll still do this stuff after
if you want to have success.
I learned that the hard way.
I had a young, young lady, she was 36,
she was a runner, she had a bunion.
I operated on her, made her big toe straight, she was happy,
sent her on her way.
About seven years later, she came back
and sat in my office and looked at me
kind of unusually and said,
"I thought you did a good job on my surgery.
Why is my bunion back?"
And I had just read Dr. Rossi and so I pulled the sock liner
which is a removable piece out of her size
seven yellow Nike running shoe.
And I put it under her foot like Dr. Rossi taught me to do.
And I superimposed her foot on it.
And she and I both had a collective light bulb moment
where I realized that my scalpel
and my screw and my saws didn't fix the problem.
The surgery temporarily made her toe go straight
but her shoes pushed it right back.
And this happens, it's happening right now.
It's not at all uncommon to have multiple bunionectomy.
And it's not uncommon for the podiatric
and the orthopedic community to consider that
to be normal and acceptable.
And in my opinion, it's not.
If people get the information
you shouldn't have to keep having an operation.
But to your earlier point,
root cause is not being addressed.
In podiatry, we're told that bunions are in your family,
it's genetic, it's hereditary, nothing you can do about it.
You might get an orthotic or you might get an arch support,
which might slow it down.
And that's also not true.
I ask my podiatric colleagues constantly,
"How is putting something up under the arch
mitigating the tapering toe box pushing the big toe up
against the second toe
or under the second toe?"
And it can't, there's no answer to that.
So bunions are not it actually, it's reverse.
When your big toe starts going towards your second toe
then your arch gets flat.
So podiatry teaches it backwards.
We teach our students, jack up that arch
and make the subtalar joint neutral
and then somehow the bunion's not gonna get worse.
It's not true.
It doesn't work.
It never has worked.
So footwear is critical.
People with bunions wanna start standing
on the removable piece that comes out of all their shoes.
And when they do that, they'll see,
they'll see a one-to-one relationship of the sock liner
or also called the insole,
is the same shape as the upper part of the shoe.
So if your foot is not completely on top of that insole
the upper part of your shoe is squeezing the toes.
And early on this is painless.
So we deform our feet into bunions and we start this,
you know, we start this at age three or four,
but it doesn't hurt.
And it happens so slowly that a lot of people
aren't really even aware of it.
In fact, a lot of folks come in and they're like,
"I looked down at my feet yesterday
and I noticed I have a bunion, my big toes crooked."
And they hadn't really drawn their attention to it
but once they do, they recognize it.
But it's a slow insidious process that can be prevented.
So basically what we wanna do is get the information
to people that the footwear's primary piece
it's not about your arch, it's not about your family.
Nearly a hundred percent of people that have a bunion
and everybody in their family that had a bunion
have feet that are wider than their shoes
for their whole lives.
And furthermore, their shoes are shaped wrong.
They're widest at the ball and getting narrower.
And for the audience, we did a three-part blog series
called, "The Hereditary Bunion Myth."
And we also did a video where we show,
we show an x-ray of a person inside
of a pointed toe box shoe
showing that the bones are held in a bunion.
And the thing about our body that I'm sure Bob
and Brad would agree with is,
if you hold your body in habitual position, it learns that.
So for instance, you and I are both sitting
in chairs right now, so our hip flexors
are starting to get a little short and contracted.
And if I sit on my phone all day and do this,
short and tight, long and weak,
so our feet are the same, Mike,
if we lift our heel, our calves get short.
If we lift our toes our front calves get short,
taper toe boxes, bunions and tailor's bunions and so forth
and weak arches.
So really bunions are mostly related to footwear.
Once you get footwear that fits you,
you're likely to be able to reverse your bunion.
- Are there any other tips
to helping reverse bunions besides footwear?
- Yeah, we have a really great rehab that we do
called, "The Bunion Stretch."
So basically, and it's on our website,
you are essentially working on the muscle
in between your first and second long bones
which is called the Adductor hallucis.
When we wear pointed shoes, that muscle draws the big toe
towards the second toe and in my case, under my second toe.
And so this rehab strategy allows the individual
audience member perhaps or anybody not needing to go
see a massage therapist or physical therapist,
can actually work on that little trigger point
that occurs in there.
And once that muscle starts to loosen up
then the big toe's gonna move away from the second toe.
But I'm careful to tell people with bunions
that even if they never touch their feet, never did any
of this rehab but just got properly fitting shoes
and used a toe spacer, it's gonna slowly change on its own.
But I always like to share the rehab
because mostly I do athletic work
and my athletes really want to get better quicker.
So we try to accelerate the recovery
with doing some of these things.
- Yeah, we talked about your Correct Toes
before the podcast started,
so I don't think we actually showed 'em yet on camera
but these are the tow spacers you guys created, correct?
- Correct.
- So do you wanna tell us a little bit how these work?
- Yeah, so I, when I read Dr. Rossi
and I started putting single spacers between my toes.
My toes did change and I felt better
and some of the back pain and knee issues
and foot issues started resolving.
But when my feet started to sweat
they wouldn't stay in place.
And this is before I had an awareness of toe socks.
And so they're sliding all around
and I'd have to stop my run and kind of put 'em back
in place and runners don't wanna stop their run, you know
for something like that.
And so I was out mountain biking with a buddy of mine
who is a designer and I was complaining a little bit
and I knew he worked in silicone and we were working
on a couple projects and I'm like, "Can we make
something that is one piece that does the same thing
so that I'm not stopping my run every three miles
to jam these things back in place?"
And he's like, "Sure we can."
And we did and we made a lot of mistakes
with our early prototypes
with materials and design and so forth.
But as we tweaked it over time,
we got it down to where we felt it was anatomically correct.
And most importantly we want people to have this
in their shoes.
And so that was also 20 years ago
and now we have four sizes
because obviously there's all kinds of different sized feet.
I would say to the audience members
the overwhelming majority of men and women wear medium
which might sound unusual, but again, it's really
we try to provide broad parameters like your shoe size
but for the audience it depends
more upon how big around are your toes.
In other words, what's the circumference of your toes?
Because that is the critical piece in terms of how your toes
fit into the cavities of the product.
- Sure. I was looking,
I actually have Brad's still in the package here.
Yeah, medium is men's size 7 to 11.
So that's what I have. I didn't know what mine were.
I don't have my package anymore.
But these are also, so yours are different
than a lot of other toe spacers , 'cause most of 'em
you can't really walk or even run in
and yours are actually functional.
- Yeah, that's our whole goal.
The others are more passive
which sometimes can have some benefit.
However, what we've discovered is where people
really get their most benefit is while they're active
and when they're weightbearing.
In other words, when they spread their toes
and when they're weightbearing,
the brain foot connection is heightened
and we get really good information from our feet
that help our brain to tell our bodies what we need to do.
So that's how we recommend it.
We do occasionally have people that wear them at night.
And we didn't early on recommend that,
we've since changed that mostly because of patient
and customer feedback.
I had a lady yesterday that told me,
she only wears them at night
but she feels more comfortable when she gets out of bed.
So that's one use for it.
But yeah, we're trying to differentiate ourselves
from the passive toe spreaders
to a more dynamic toe spreader.
- Yeah, I mean it is easy to wear 'em in bed
'cause you just, you're not paying attention,
they're just there stretching all night.
So it's nice passive way.
And yours also have, yours are different
because you can expand the fifth toe
or the first toe as well.
So if you need more spacing that can help as well.
- Correct, yeah, so just like we want to take a really slow
gradual approach to accommodating natural footwear
which is also sometimes called minimal footwear.
The industry also likes to currently call it,
barefoot footwear.
We start with the conventional
or the separator the way it is
and then depending upon the level of deformity
of either the big toe or the fifth toe,
we can at some point down the road
and usually it's probably three to six months,
we can start to put another little piece
of material in there.
And what we like to use is the sock liner
that comes out of the shoe.
We've usually have people leave that out anyway
because it's just foam and most athletic shoes
are soft enough under that.
So we have people cut a little chunk out of their sock liner
and take a bathroom tweezer
and just pull it down through there.
Or you can just push it into the little cavity
so that slowly over time,
if you've got a regular bunion on the big toe
or you've got what's called a bunionette
where your fifth toe is coming in under
you might eventually wanna put more material
into that outer cavity to push your fifth toe
out a little bit more.
- Sure. Yeah, 'cause that's what I need 'em for.
I actually don't have a bunion, luckily, my dad has one.
But yeah, that's what I find the benefit
is getting the fifth toe out there and like Brad has,
yeah kind of bunions and cross toes
and Bob has a hammer toe.
So we have all sorts of foot issues on our side.
Good thing we found you, huh?
- Yeah.
- All right.
Is there anything else to add
about bunions for switch topics?
- Not that I can think of.
Oh, actually I take it back.
One more thing, Mike.
It's interesting, sometimes people will have bunions
only on one foot and that is a curiosity to them.
They ask, well if I've got the same influences with shoes
why am I only getting one bunion on one foot?
And usually that's related to the bunion foot having,
the bunion foot's a longer foot typically
which means there's more of the toes in the tapered part
in the toe spring.
I also find that there are body asymmetries.
And so if I see a bunion on one foot,
I might also send that client out to my physical therapy
or body worker friends to have a whole body evaluation,
ranges of motion, muscle testing, testing for weakness,
testing for contracture,
to see if there might be something else
further up the chain.
And I also have found that when people have a leg
that's longer than the other,
that foot that's longer will sometimes pronate more
which also can sometimes have a relationship
to the big toe joint function.
So footwear is the first thing to look at
but I also strongly encourage a whole body evaluation.
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