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In page Syndesmosis procedure:
"Female hormone estrogen and genetic inheritance are the two primary factors behind the weak ligaments of bunion feet. Bunion deformity was found more common in people wearing shoes by a study in Hong Kong[2] and increased in Japan due to changing in footwear to Western style.[3] Aging, degeneration and trauma have also been attributed to weakening of the responsible ligaments.[citation needed]
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