InAlign Blog 11-08-18: 5 – Psych Survey – Prototype device review

At the end of the interview, the InAlign prototype device was shown. They could see it, feel it, ask questions about it, say what they liked about what they saw, and asked what they would need to know before they would buy it. 

This is a summary of their responses.

“It looks good, simple, and aligns the toes properly and is somewhat loose around the toes so it doesn’t cut off blood circulation. Not bulky, light weight, thin enough to wear in most shoes, easy to put on and take off, not complicated.” 

What else would they want to know about it? 

“More colors would be nice (their model was clear). They’d want to see doctor recommendations, want to know if it’s comfortable for all day wear, want anti-fungal properties, want to see legitimate testing, ratings from other users, and testimonials. They would like more than one pair to alternate days of use. Some mentioned absorbable material where it touches the skin. Most would like a trial period with return policy.”

What would they pay for the device? 

From $50 to $1000. Most were in the $100-$300 price range.

InAlign Blog 11-08-18: 4 – Psych. Survey – Bunion products they’ve used

There are several products on the market for various issues related to bunions. 

“Better shoes”, as I related earlier, is a valuable choice. “Better” means several things, including fashionable. Comfortable usually comes down to padded footbed, wider, less pointy toe box, and flexibility and flexibility in the right places. Over the years, many of the women said shoe choices have improved. Some shoe stores focus exclusively on “comfort” shoes and may allow customers to wear the shoes at home for a week or two, to assess comfort better.

Custom and off the shelf orthotics. Most use them. Custom orthotics are partially covered by insurance, until you’re on medicare. Medicare doesn’t cover custom orthotics. So, just when your feet hurt the most from bunions, they’re not going to cover them. Insensitive, stupid, and mean, in my opinion. 

The main products that focus on specific toe issues fall into the categories below. However, almost none of our interviewees buy them and use them. They may have tried them but found them to be inadequate for several reasons. These categories are:

Bunion pads that pad the bunion bump, reducing pressure and wear on the bump. You’ll need even wider shoes, depending on the thickness of the pad. 

Splints, which straighten the big toe. But they can’t be worn in shoes, make walking difficult, and really aren’t comfortable to wear to bed at night as they catch on bedding or annoy your partner.

Toe spacers or separators. Typically soft silicone pads between the toes, usually just the between the big toe and the second toe. They can be worn in some shoes. They will cut off blood circulation to the toes if they are too tight. And they tend to slip and slide around if you are active.

Toe stretchers that stretch out all the toes. You can’t walk in them. Can’t be worn in shoes, either. They can only be worn for short periods of time. They provide short, temporary relief. Yes, it feels good like a good stretch. But you don’t stretch anything for 8 hours, so, short term only.

These products sell for prices from $2 to $65. Custom orthotics cost from $300 to $800. Quarterly pedicures are about $45 each quarter.

Overall, the problem with toe spacers is their comfort level. They are really not comfortable on the underside of the toes. They’ll move around when worn, get moist from sweat resulting in being slippery, they’ll rip, they’re too soft to really align the big toe and can’t uncross crossed toes. Interviewees did not like them or any of the other products, save for some bunion pads. 

InAlign Blog 11-08-18: 3 – Psych Survey – Progression of their bunions

Bunions get worse over time. Bunions became issues for this group sometime between their 20’s and 40’s.

Only 3 of 10 had surgery, due to severe deformity and pain. Some may yet have surgery, or have it a second time. For the others, the achey feet, crossed toes, hammer toes, and other complications were painful enough to seek medical help, but surgery was decided against. 

Conservative treatment means wearing wider more comfortable shoes, buying custom or off the shelf orthotic shoe inserts, taking off the shelf pain medication, using topicals like lidocaine creams, massage, and putting their feet up. 

Pain and discomfort are the reason they will visit a podiatrist. This means they have usually been living with bunions for good period of time before getting professional help. Almost everyone with bunions is aware that surgery is the last resort and that wearing custom or off the shelf orthotic inserts is something they can do themselves. Off the shelf orthotics are available in almost all shoe stores or departments, so they do not need to see an MD in order to get them. Some have decades of orthotics stored away. I personally have over 40 sets in a bag in my closet.

As a result, almost all the women wear or have worn orthotic shoe inserts for most of their lives. These do, generally, provide comfort and some pain relief, but cannot be worn in all their shoes. This is especially true for women who wear more shoe styles than men. 

It’s the narrow pointy toe box. The suggestion to wear wider shoes is not as simple as it sounds. Wider shoes means poorer overall fit and wider, loose heels. Yes, less rubbing on the bunion itself. But at a trade off with ill fitting shoes, overall. But often it’s not the width of the shoe that’s so critical, it’s the narrow, pointy toe box that is the problem. Women, more-so than men, have more of those kinds of shoes.

There’s more. As one female friend told me, that cute size 8 shoe on display isn’t so cute at size 11. Do men have that problem? I don’t think so. Shoes are a more complex issue for women.

InAlign Blog 11-08-18: 2 – Psych Survey – Lifestyle Impacts

Lifestyle changes are the larger, direct, and indirectly medical impact of bunions. Indirectly medical because being more sedentary is not a positive lifestyle change.

Style of dress. Bunion issues will change how a person decides to dress. No one wants to wear ugly shoes with more fashionable attire. But some will, if they have to.

Activity levels, while intending to stay high, require bunion sufferers to adapt. They do less on their feet: stopping activities they may have grown to love, change life plans, such as travel, reducing vigorous exercise so they can avoid pain and discomfort or rest their feet. It is generally accepted that being sedentary is bad for your overall health, so this is not a good sign for bunion sufferers. While many are very creative in their ability to adapt and they do keep active, it requires constant adaptation as they get older. 

Technology. We asked about technology use for this group of 55+ patients. While all use email and shop online (Amazon and others), they don’t shop for shoes online because fit is so important. It’s critical to try them on in the store. Some used FaceBook, none of the 10 used Instagram, Twitter, Snapchat, or Reddit.

InAlign Blog 10-31-18: 1-Psych Survey – Overview

A Psychographic Survey of Women with Bunions.

There is a difference in how women and men experience bunions.

First, some facts:

     – Twice as many women have bunions as men. 

     – At 60 years old, 50% of women have bunions.

     – Women wear more shoe styles than men.

     – Women’s muscles, tendons, and ligaments are generally more flexible, stretchable, and lax, especially during pregnancy, than are men’s.

I put together a 50 question psychographic survey and interviewed 10 female patients of a podiatrist friend of mine. The interviews lasted about 45 minutes each.

Here’s what I learned.

All the patients had bunions for years if not decades, all had a family history of bunions, many had already had bunion surgery earlier in their lives, or multiple surgeries, and may need it again.

As a result of bunions, many also had “crooked” toes, meaning the other toes were bending outward, or toes were crossed over/under the big toe, along with hammer toes, or in one case, had their second toe amputated. A few had other foot issues which may or may not be directly related to bunions, such as, neuromas, plantar fasciitis, and arthritis affecting the toes. Bunions were the primary reason for visiting the podiatrist, but the impact of the bunions on the rest of the toes and foot are related.

Women will intensify their search for comfort shoes, as their bunions worsen and discomfort increases. But comfort isn’t the only consideration, style is, too. This is a larger issue for women, as they wear shoe styles that go with their style of dress. They have far more choices to make, and more shoes, than men. 

Sadly, many shoes that are truly comfortable, such as athletic or orthopedic shoes, are not fashionable enough to wear, depending on clothing style and activity. Wearing athletic shoes with most fashionable clothes is a frustrating choice to have to make. As a result, putting up with some discomfort becomes the norm. Many women carry along an extra pair, often several, of different styles of shoes, during their normal day. 

Compromises of comfort over fashion is a constant theme. The result may be more comfort, but the downside is a lamentable closet of well loved shoes that can’t or won’t be worn anymore.

For men, the same issues arise, but to a lesser degree. Shoes styles don’t have the same impact on their fashion choices and style of dress as they do for women. Still, the issue is comfort with fashion, and the choices are less complex for men than women.

InAlign Blog 10/30/18: What is alignment?

What is alignment? What does alignment do?

Podiatrists consider the normal angle of the big toe to be between 0 and 15 degrees. It’s a problem if its greater than 15 degrees. 

My big toe is 30 degrees. The first prototype I made, the one I wear daily, moves my big toe to 20 degrees, a 10 degree improvement. My design requirements for the next model, the one you’ll be able to buy, will move my big toe to 10 degrees. It will be in the normal range.

Here’s a picture…

My foot, the device, the device on my foot. 

My big toe is angled leftward to a more normal angle. My second toe is now adjacent to my big toe, not on top of it. Plus, it’s hammer toe protrusion is pushed down a bit. The third toe is now adjacent to the second toe as it would normally be. 

That’s what alignment is!

What does alignment do?

It changes the angles of the muscles, tendons, and ligaments. They now operate in their normal planes of action, not all kittywampus like they were. 

It also lessens the abnormal pressure points in the ball of the foot that are caused by the misaligned angles of the toes where they join the metatarsal joints.

In the larger picture, gait is improved along with balance, and the upstream impacts to knees, hips, and low back are lessened. 

Less pain and discomfort, more comfort, better gait and balance. That’s what alignment does!

I know you want me to tell you that your bunions will go away if you wear this device, but they won’t. We’re not making that promise and you should be skeptical if someone does.

There isn’t a single formal study that demonstrates that devices like this will lessen or remove the bunion itself. Though, you will hear promises. The best you can do is to wear this device for all day comfort.

You can and should do other things. Wear wider shoes, wear orthotics, and do specific toe and foot exercises (we’ll be posting them in the future).

Finally, don’t wear tight, pointy toed shoes or high heels. Right, as a man, I don’t tend to do that anyway, and I still have bunions! My grandma, who never wore pionty shoes or heels, had horrible bunions. But we’ll have a few blogs on women with bunions and how their experience differs from men’s. Twice as many women as men have bunions and it’s not just because they wear high heels. After all, many women wear heels and do not have bunions. Genetics is always a factor, but so is environment.

InAlign Blog 10/29/18: Why did I make the InAlign bunion device?

Why did I make the InAlign bunion device?

Because, at 70+ years old my bunions are worse than ever. But there’s more.

Here’s the issue, it’s not just about the bunion itself, is it?

Bunions generally push the big toe outward (hallux valgus). It’s misaligned.

This has downstream implications that get worse over time. Over the years, hallux valgus has impacted my second toe which now crosses over the top of my big toe. I’ve developed a hammer toe, where the joint of my second toe pokes up and rubs the toe box of my shoes. The third toe, now, is curled towards my second toe which isn’t there since it’s on top of my big toe.

My toes are out of alignment, as are many of yours. As one orthotist (they make custom orthotics) told me, “You have gnarly toes!” Gnarlier now than 15 years ago when he first made the comment. All this gnarliness affects balance, too. Gnarly toes equals foot discomfort. Which affects gait, which affects you up and down your whole body.

Of course, since I’m a “senior”, over the decades I’ve bought all the devices that attempt to straighten my toes. They didn’t and I didn’t like them. They’re either too soft or you can’t wear it with shoes or while walking.

I want my gnarly toes aligned all day, everyday, in all my shoes, for all my activities.

That’s why I made it.

I’ve been wearing my prototype for 2 years…All day, everyday, in all my shoes, for all my activities.

You can, too!